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Table 2 Theoretical background for scoring DUNDRUM-3

From: Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

Units of meaningful change Cycle of change [19] Engagement [18] Recovery [20] Hierarchy of needs [21] Spiritual and cultural integration
4: not ready to move down a level of security Pre-contemplation. Reluctance/ resistance Moratorium Physiological needs Alienated
3: ready for a move e.g. from high to medium security Contemplation & preparation, ambivalence Passive engagement Awareness, finding hope Safety and basics of life Can engage only in ‘trading’ interactions on an impersonal or binary basis.
2: ready for a move e.g. from medium to low security Action / decisional balance Active engagement Preparation, search for personal resources and external help, taking responsibility Friendship and family relationships Accepts and commits to communal and social customs and affiliations.
1: ready for a move to supported community living e.g. conditional discharge or community treatment order Maintenance, supported Positive engagement Rebuilding, taking positive steps, establishing a positive identity Self-esteem, confidence, social standing Accepts and commits to communal and social concepts of value and virtue.
0: ready for independence Maintenance, stability Taking personal responsibility Growth / sense of control / looking forward, finding meaning and purpose in life Self-actualisation
Expresses self in creative and communicative ways.
Self-transcendence
Fulfils roles and shares own resources (time, effort) for communal good