What works for whom? Personalizing the use of technology in forensic psychiatry: a systematic scoping review on factors determining effectiveness

Forensic psychiatry operates at the intersection of psychiatry and the law (Gutheil, 2004). The focus lies on the assessment and treatment of people with mental health disorders who have committed a crime or are at risk of committing offences (Mullen, 2000). Patients in forensic settings often have complex comorbidity, including high rates of substance use and personality disorder (Patterson et al., 2021; van Buitenen et al., 2021; Young et al., 2018). Moreover, they are at high risk of violent or sexual offending, and therefore receive treatment shaped by criminological models such as the Risk-Need-Responsivity (RNR) model (Wormith & Zidenberg, 2018). Their treatment is often compulsory, which might severely decrease their treatment motivation (Koeyvoets et al., 2024). Research on the effectiveness of current treatments in forensic psychiatry shows mixed outcomes and room for improvement (Gilling McIntosh et al., 2021; Goulet et al., 2022). In addition, current treatment approaches such as cognitive behavioral therapy are often focused on thinking, talking and reflecting. However, as many patients have low literacy and cognitive skills and difficulty reflecting on their behavior, these reflective, language-based approaches are not always the best match for this target group (Kip et al., 2025; A. Ter Harmsel et al., 2021). Novel technologies have the potential to reshape forensic care from primarily talk-based therapy to more engaging, adaptable and personalized treatment, for instance through real-time biocueing or with immersive VR experiences (Klein Haneveld et al., 2025; Ter Harmsel et al., 2021). In addition, they could contribute to treatment effectiveness and efficiency in current times of staff shortages and limited resources (Kip et al., 2021). Technologies such as virtual reality, mobile apps and wearables are found promising by stakeholders in forensic mental healthcare, though there needs to be a good fit between the patient, professional, technology and context (Kip et al., 2021). A previous systematic literature review on technologies for the treatment of offenders found examples of web-based programs, telepsychiatry, and other tools but emphasized that the evidence base was small, heterogeneous, and more focused on feasibility and acceptability than on effectiveness or implementation outcomes (Kip et al., 2018). Since then, several developments have increased both the volume and the diversity of digital work relevant to forensic settings. The COVID-19 pandemic accelerated the use of technologies across forensic care (Kirschstein et al., 2023), and novel technologies such as wearables and VR interventions have begun to be trialed in secure settings (De Looff et al., 2024; Sivermo et al., 2025). Due to the rapid pace of technological development in forensic psychiatry, there is a need for an updated overview of the possibilities of using technology. Furthermore, a key takeaway from the previous literature review and related research is that we need to move towards personalized approaches as the one-size-fits all approach is unfitting for forensic psychiatry. Reasons for this can be partially found in the complexity and heterogeneity of the field: there is large variety in types of offense, diagnoses, treatment settings, and cognitive skills (Kip et al., 2018, 2021; Ter Harmsel et al., 2023). In general, responsivity is an important part of forensic care, to ensure that treatment fits individual needs of the hard-to-involve forensic population (Taxman et al., 2013). This principle can also be extended to technology (Kip & Bouman, 2021). Therefore, knowledge on general effectiveness of technologies is not sufficient. Rather, more insight is needed into which types of technology work best for which types of patients, and why (Kip et al., 2021). Only then can we use technologies in personalized ways, tailoring the choice and use of digital mental health intervention to patient, treatment, and provider characteristics. Since personalization is increasingly recognized as crucial to effectiveness in digital mental health interventions in general (Gan et al., 2022; Lustria et al., 2013; Tong et al., 2021), this is an essential avenue for further research. In conclusion, an updated review is needed to map what has changed in recent years, and identify which technologies and study designs have proliferated (or not). Furthermore, it will help to gain first insights into factors that can determine why a technology does or does not work for a patient. Accordingly, this review aims to answer the following questions: • Which types of technology are being researched in the treatment of offenders, and with what goals? • Which target groups and treatment settings are these technologies aimed at? • What factors are found or expected to be related to the effectiveness of these technologies?