Violence and leveraged community treatment for persons with mental disorders.
ABSTRACT This article explores the link between violence and the practice of legally mandating treatment in the community or leveraging benefits from the social welfare system, such as subsidized housing and disability income support, to ensure adherence to treatment.
Data are presented from a survey of 1,011 persons with psychiatric disorders receiving treatment in public mental health service systems in five U.S. cities. Multinomial logit analysis was used to examine the association between physically assaultive behavior and experience of social welfare leverage, legal leverage, or both types of leverage, with the analyses controlling for demographic and clinical characteristics.
Across study sites, 18% to 21% of participants reported having committed violent acts in the past 6 months; 3% to 9% reported having used or made threats with a lethal weapon, committed sexual assault, or caused injury. About three-quarters of subjects who reported such serious violence also reported having experienced some form of leveraged treatment, compared with about one-half of subjects who did not report serious violence. Demographic and clinical factors that were independently associated with the likelihood of experiencing both types of leverage included younger age, male gender, poorer clinical functioning, more years in treatment, more frequent hospitalizations, higher frequency of outpatient visits, and negative attitudes toward medication adherence. Among participants who did not voluntarily take psychotropic medication, even minor assaultiveness was associated with having experienced legal leverage.
A combination of concerns about safety and treatment nonadherence may influence decisions by clinicians and judges to apply legal leverage.
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ABSTRACT: Schizophrenics are at increased risks of violence and of committing homicide as compared to the general population. The objective of this review was to examine which factors were associated with schizophrenia, and to assume a “homicidal crisis” and an analysis tool of the homicidal potential. First, the authors highlighted that male gender, a young age, a low socioeconomic status, a history of violence and alcohol abuse could be considered as general homicide-related factors, while drug abuse, personality disorders, clinical paranoia, delusions of persecution, religious or not, delusions of grandeur, lack of insight, disorganized thinking, a lengthy duration of untreated psychosis, or a monitoring or treatment which were discontinued were more schizophrenia-specific factors for homicide. Secondly, the urgency of homicide plans (place, time, conception, preparation of the homicidal scenario, frequency and intensity of homicidal thoughts) needed to be completed by the danger of the homicide itself (lethality and accessibility of murder weapon). The relationship between past and current episodes of aggressive behaviour reinforces the importance of including a careful assessment of past history of violent behaviour as part of the routine psychiatric evaluation.Annales Médico-psychologiques revue psychiatrique 02/2010; 168(1):62-68. · 0.15 Impact Factor
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ABSTRACT: Objectives. In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. Methods. Baseline data were pooled from 5 studies of adults with mental illnesses from across the United States (n = 4480); the studies took place from 1992 to 2007. The MacArthur Community Violence Screening Instrument was administered to all participants. Results. Prevalence of perpetration ranged from 11.0% to 43.4% across studies, with approximately one quarter (23.9%) of participants reporting violence. Prevalence of victimization was higher overall (30.9%), ranging from 17.0% to 56.6% across studies. Most violence (63.5%) was perpetrated in residential settings. The prevalence of violence-related physical injury was approximately 1 in 10 overall and 1 in 3 for those involved in violent incidents. There were strong associations between perpetration and victimization. Conclusions. Results provided further evidence that adults with mental illnesses experienced violent outcomes at high rates, and that they were more likely to be victims than perpetrators of community violence. There is a critical need for public health interventions designed to reduce violence in this vulnerable population. (Am J Public Health. Published online ahead of print February 13, 2014: e1-e8. doi:10.2105/AJPH.2013.301680).American Journal of Public Health 02/2014; · 3.93 Impact Factor