Table 2.

Theoretical background for scoring DUNDRUM-3

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