A systematic review of dramatherapy interventions which are used to support adult participants’ mental health in forensic settings

A growing number of people in the criminal justice system require mental health care. At the same time, in the UK at least, gaining access to forensic mental health services is becoming increasingly difficult. Dramatherapy, which may be a useful treatment in forensic settings, such as prisons and secure hospitals, has not before been systematically reviewed in this context. Seven databases and 10 journals were searched for all available literature. From 6724 sources, 12 papers were suitable for inclusion. Data relating to participant and intervention characteristics, methods used to measure effect, and qualitative and quantitative effects were extracted. Quantitative data were used to calculate effect sizes (Cohen’s d) and qualitative data were subjected to content analysis. Varied participant and intervention characteristics suggest flexibility in provision, however, forensic dramatherapy was most often delivered in the UK (33%) to groups (66%) of male (75%) adults with personality disorder (42%). Effects were measured both qualitatively and quantitatively; the use of quantitative outcome measures (42%) and the collection of participant feedback (42%) were most popular. Effect sizes ranged from d = 0.01 to d = 1.25. Large effects were seen with regards to reduced anger and increased emotional activation, however, studies were often uncontrolled. Qualitative results suggest that participants experienced new ways of being, were able to express themselves and felt supported by the group or therapist. The quantitative and qualitative results of forensic dramatherapy suggest promise, however, the evidence base is currently small. Further, methodologically strong research is encouraged.