Purpose: This study aims to investigate the perspectives and experiences of treatment facilitators regarding the effectiveness of treatment they delivered for high-risk offenders with complex needs. Within this study, the term complex needs refers to an individual who is managing several issues, such as physical illness, mental health issues and addiction disorders. Design/methodology/approach: There was a total of 18 semi-structured qualitative interviews conducted with treatment facilitators from Australia and the UK. This study presents two key themes that emerged from the thematic analysis: “the importance of responsivity and active/creative activities in practice” and “the practitioner’s core concerns: issues with high-risk offenders treatment accessibility”. Findings: The findings revealed that treatment facilitators considered treatment responsivity as core to treatment for high-risk offenders with complex needs and that active/creative activities were beneficial in achieving this. Additionally, treatment facilitators expressed concerns around the inaccessibility of treatment, including the barriers of talk therapy and the inability for offenders to receive the level of support necessary. Considering these findings, this study offers a discussion on the potential value of music therapy as a component of treatment for such offending populations. Social implications: The empirical data yielded from the interviewed treatment facilitators highlight that music therapy can play a role in supporting the beneficial components of treatment programs. Further implications centre on addressing the limitations of treatment that were identified through the interviews. Originality/value: This study focusses on exploring the role of music therapy with high-risk offenders and who have complex needs when engaging in treatment programs. This paper recognises that the application and use of music therapy with this cohort has been neglected in the academic literature and research until recently.