Recovery and desistance in mentally ill offenders can be more complicated than in respectively general psychiatric or offender populations due to factors and processes on individual, contextual and structural levels. In this paper we focus on a specific element of the interplay between the individual and the contextual level; the working alliance. Beneficial working alliances during (quasi-)compulsory treatment and offender supervision can facilitate recovery and desistance in mentally ill offenders. These alliances are however characterized by a tension between care and control and further complicated by mentally ill offenders’ experiences of trauma and stigma. To our opinion, a procedurally just approach can counterbalance these two difficulties by setting a sound rehabilitative climate in which recovery and desistance can be facilitated in mentally ill offenders. We support our argument by a critical review of findings from theoretical papers and empirical research studies from psychological-psychiatric and legal-criminological scientific domains on the subjects of recovery, desistance, (quasi-)compulsory treatment processes, and procedural justice. A procedurally just approach can be valuable for policy, treatment as well as future research regarding recovery and desistance in mentally ill offenders.