Violent Behavior Preceding Hospitalization Among Persons with Severe Mental Illness

The need to better understand and manage risk of violent behavior among persons with severe mental illness (SMI) in community care is increasingly being recognized. Of particular concern is a subset of the SMI population characterized by a revolving door pattern of institutional recidivism and poor adherence to outpatient treatment. Little empirical research exists which examines the specific dimensions of violent incidents and their surrounding context in this population. The present paper describes characteristics of violent behavioral events in a sample of 331 people with psychotic or major mood disorders who were placed on involuntary outpatient commitment in North Carolina. By pooling baseline data from respondents' self-report, collateral informant interviews, and hospital records, the study found violent behavior to be a problem affecting over half the sample in a 4-month period preceding hospitalization. The study also found considerable variability in the frequency of violent events, severity, weapon use, subjective state when incidents occurred, initiation of fights, settings, relationship to others involved, and associated threat of victimization. Multivariable analyses showed that cooccurring substance abuse problems, history of criminal victimization, and age (being younger) were significantly associated with violent behavior when all sources of data were taken into account. Clinical diagnosis and symptom variables were not related to violence in this sample. Implications of these findings for service delivery priorities and future research are discussed.     

Do prior histories of violence and mental disorders impact on violent behaviour during encounters with police?

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services.     

Exploring Agreement on Appropriate Responses to Domestic Violence and Sexual Trauma Across Victim Advocates,Mental Health Service Providers,and Substance Abuse Treatment Providers

Abstract

Research suggests that survivors of domestic violence and sexual assault are more at risk than the general population for substance abuse and/or mental health disorders (Kendler et al., 2000). Additionally, research suggests that survivors of both crimes are at risk to be “multiply diagnosed-have” a history of victimization, a mental health diagnosis, and abuse of alcohol and drugs (Steele & Rechberger, 2002). While advocates have called for a change in the treatment of trauma survivors to treat their multiple needs, the availability of collaborative care between victim advocates and behavioral health professionals remains questionable. Using survey data collected from victim advocates, mental health service providers, and substance abuse treatment providers, this study assesses the extent to which providers of different backgrounds agree on how to effectively and appropriately serve domestic violence and sexual assault survivors-the first step in achieving the goal of holistic care.     

Heterosexual intimate partner homicide: review of ten years of clinical experience

Most of the literature on intimate partner homicide addresses violence between the two partners, spousal abuse, and family violence. There is less focus on the relationship of mental illness, intellectual functioning, and drug and alcohol abuse to these homicides. We investigated this type of homicide in a collection of forensic cases seen by the first author over a period of 10 years. Twenty-eight patients who underwent forensic psychiatric evaluation for heterosexual intimate partner homicide from August 1993 to June 2003 were studied using a retrospective case review methodology. We found that firearms were used as the method of killing more often by females than by males. We also compared method of killing with substance abuse and intoxication at the time of the homicide. Educational status indicates that this group of accused perpetrators is functioning at higher intellectual levels compared with a previously studied sample of filicides. We also found significant presence of serious mental illness in our sample of accused perpetrators of heterosexual intimate partner homicide.     

Adolescent homicides in Finland: offence and offender characteristics

Approximately 9% of the homicides in Finland are committed by adolescents under 20 years of age. The purpose of this study was to investigate the offence and offender characteristics in homicidal adolescents. Forensic psychiatric evaluation statements of adolescent offenders accused of a homicide during 1990-2001 were reviewed retrospectively (n=57). In 38% of the cases, there were multiple offenders. In 58% of the cases, the victim was an acquaintance, in 25% a stranger, in 12% a family member and in 5% of the cases an (ex)intimate partner. Sixty-nine percent of the offenders were intoxicated and 21% under the influence of drugs at the time of the killing. The most frequent motives were an argument (25%) and a robbery (25%). Sixty-four percent of the offenders had developmental problems and 42% had a crime history. Approximately half were diagnosed as having a conduct or a personality disorder, but 32% of the offenders were considered not to suffer from a mental illness or substance abuse. For 63%, the level of intellectual functioning was average or above average. There were signs of more than one form of violence in 54% of the cases and 28% of the cases contained excessive violence. The use of multiple and excessive violence was significantly related to the offender age, multiple offenders, offender-victim relationship and substance abuse, but not related to having developmental problems, crime history or mental illness.     

Co-occurring serious mental illnesses and substance use disorders as predictors of assaultive infraction charges among adult male jail inmates

This study used self-report data from 4642 adult male jail inmates to test the hypothesis that inmates with co-occurring serious mental illnesses (SMIs) and substance use disorders (SUDs) (i.e. co-occurring disorders) would report having been officially charged for assaulting staff or inmates more often than inmates without co-occurring disorders. Negative binomial regression indicated that relative to inmates with neither SMI nor SUDs, assault charges were most likely to be reported by inmates with co-occurring SMI and substance abuse, co-occurring SMI and substance dependence, and only substance abuse, respectively (ps ≤ .01). Having been charged with assault was also strongly associated with assault victimization before and while incarcerated (ps ≤ .05). This article concludes with recommendations for jail policies and future research.     

Youth violence: an exploratory study of a treatment program in a central Illinois county

A local treatment provider has developed an OPTIONS program to prevent adolescent aggression. The program is designed for youths who displayed threatening or abusive behaviors, particularly toward family members. This study described the characteristics of juveniles and their families who were referred to the program and if the program participation helped reduce the severity of violence and improve the communication skills among program participants. Referrals came from law enforcement, juvenile court services, school resource officers, and parents. Information on 100 juveniles and their families were provided by the counselors of the program. The findings showed that a large percentage of juveniles came from unstable families with a family history of criminal convictions, substance abuse, or mental illness. Program participants showed an improvement in communication skills and reduction in their levels of dangerousness.     

Gender Differences in Child Abuse and Intergenerational Transmission of Crime and Substance Abuse among Israeli Inmates

The aim of this study was to examine the gender differences in various types of childhood abuse and family history of crime, substance abuse, and mental health problems. Our study was conducted among 110 Israeli female and male inmates (50 female and 60 male inmates). The findings indicated a higher rate of multiple types of childhood abuse among the female inmates compared with the male inmates. The findings also revealed that female inmates reported more prevalence of parents’ substance abuse, crime, and family’s mental health problems than the male inmates did. Moreover, the female inmates reported higher rates of emotional, physical, and sexual abuse associated with family history variables compared with the male inmates. Furthermore, the findings indicated that female inmates whose siblings were involved in substance abuse and crime reported higher rates of sexual and emotional abuse compared with the male inmates. We discussed the implications of these findings.     

Factors related to suicide in New York state prisons

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.     

Poor parenting and antisocial behavior among homeless young adults: links to dating violence perpetration and victimization

Though research has examined risk factors associated with street victimization among homeless young people, little is known about dating violence experiences among this group. Given homeless youths' elevated rates of child maltreatment, it is likely that they are at high risk for dating violence. As such, the current study examined the association between child maltreatment and parental warmth with dating violence perpetration and victimization through substance use and delinquency among a sample of 172 homeless males and females. Results from path analysis revealed that physical abuse, sexual abuse, and neglect were all significant correlates of both substance use and delinquency, whereas lack of parental warmth was only associated with substance use. Neglect and substance use had direct effects on dating violence and substance use and was found to mediate the relationship between physical abuse and dating violence. Finally, females, older youth, and non-Whites had significantly higher levels of dating violence compared with their counterparts.     

Mental health correlates of the victim-perpetrator relationship among interpersonally victimized adolescents

This research examines mental health correlates of different victim-perpetrator relationships among adolescent victims of interpersonal violence. A large and nationally representative sample of adolescents (N = 4,023) responded to structured telephone interviews concerning mental health functioning (posttraumatic stress disorder-PTSD, major depressive disorder, substance abuse/dependence, and delinquency). Those reporting histories of sexual (n = 321) and/or physical (n = 688) assault were queried about specific aspects of their assaults, including their relationship with the perpetrator. After controlling for demographic and assault-related risk factors, the victim-perpetrator relationship remained a significant risk factor for mental health problems. Adolescents sexually assaulted by nonstrangers were at increased risk for PTSD; those sexually assaulted by acquaintances or people they did not know well were at increased risk for delinquency. Adolescents who were physically assaulted by a family member were at increased risk for PTSD. Explanations for the findings and the need for consistent assessment methods across related studies are discussed.     

Substance Use and Intimate Violence Among Incarcerated Males

The purpose of this study was to examine substance use patterns among a sample of incarcerated males who report engaging in levels of intimate violence, as well as identifying similarities and differences in demographic, economic status, mental health, criminal justice involvement, relationships, and treatment factors for three groups of incarcerated males - those who report perpetrating low intimate violence, those who report perpetrating moderate intimate violence, and those who report perpetrating extreme intimate violence the year preceding their current incarceration. Findings indicated that low intimate violence group's perpetration consisted almost exclusively of emotional abuse. Moderately intimate violent males and extremely intimate violent males, however, report not only high rates of emotional abuse but physical abuse as well. The distinction between moderate and extremely violent groups was substantial. Findings also indicated that perpetrators at different levels of violence in this study did not vary significantly in age, employment history, marital status, or race. However, the three groups showed significant differences in three main areas: (1) cocaine and alcohol use patterns, (2) stranger violence perpetration and victimization experiences, and (3) emotional discomfort. Implications for substance abuse and mental health treatment interventions and for future research are discussed.     

Factors Associated with Domestic Violence and Sexual Assault Victimization

This study explored factors associated with a lifetime history of domestic violence and sexual assault in a sample of welfare recipients in Illinois. Results indicate that childhood exposure to domestic violence is a risk factor for both sexual assault and domestic violence victimization, but that childhood physical abuse is only a risk factor for domestic violence. Increased education and employment skills and having more children were also risk factors for domestic violence victimization. Domestic violence was significantly associated with depression, while sexual assault was associated with low social support and a greater perceived need for mental health services. Frequent alcohol and drug use were not associated with either type of victimization. Research implications are discussed.     

Stressful Childhood Experiences and Clinical Outcomes in People with Serious Mental Illness: a Gender Comparison in a Clinical Psychiatric Sample

Objective: This study examines stressful childhood experiences (SCE) including childhood abuse and family context in a cohort of 183 people diagnosed with serious mental illness (SMI) and compares gender specific rates of SCE and clinical outcome variables. Methods: 111 men and 72 women with SMI were interviewed regarding SCE and posttraumatic stress disorder (PTSD) symptoms, dissociative symptoms, risk for self-harm, and adult re-victimization. Results: Both genders endorse high rates of SCE. Cumulative SCE (the sum of seven SCE) are linked to increased levels of all four outcome variables after adjusting for demographic factors. Conclusions: The study addresses the need to assess cumulative SCE in a population with SMI and its effects on clinical outcomes in both genders.     

The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behavior Problems

This study examines the effects of child abuse and domestic violence exposure in childhood on adolescent internalizing and externalizing behaviors. Data for this analysis are from the Lehigh Longitudinal Study, a prospective study of 457 youth addressing outcomes of family violence and resilience in individuals and families. Results show that child abuse, domestic violence, and both in combination (i.e., dual exposure) increase a child’s risk for internalizing and externalizing outcomes in adolescence. When accounting for risk factors associated with additional stressors in the family and surrounding environment, only those children with dual exposure had an elevated risk of the tested outcomes compared to non-exposed youth. However, while there were some observable differences in the prediction of outcomes for children with dual exposure compared to those with single exposure (i.e., abuse only or exposure to domestic violence only), these difference were not statistically significant. Analyses showed that the effects of exposure for boys and girls are statistically comparable.     

High Risk Behaviors Among Victims of Sibling Violence

Despite the fact that sibling abuse has been documented as the most common form of intrafamilial abuse, it has been largely overlooked. Using data from the 2007 Delaware Secondary School Student Survey (N = 8,122), this paper focuses on four objectives: to estimate prevalence of sibling abuse, examine the relationship between sibling violence and high risk behaviors such as substance use, delinquency and aggression, explore the interplay of sibling abuse and other forms of family violence in predicting high risk behaviors, and test theory. Results suggest that sibling violence occurs more frequently than other forms of child abuse. Results also confirm that sibling violence is significantly related to substance use, delinquency, and aggression. These effects remain significant after controlling for other forms of family violence. The data suggest support for feminist theory and social learning theory.     

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.     

Use of a Social–Ecological Framework to Understand How and Under What Conditions Family Violence Exposure Affects Children’s Adjustment

The proportion of children experiencing violence in the home is disturbingly high, with many also being victims of violence outside the home. Therefore, smaller, innovative or preliminary studies were invited in order to better understand how exposure to violence across different ecologies independently or interactively influences the risk for maladaptive outcomes. This special issue is predicated on the notion that risk for maladaptive outcomes is contextualized by one’s individual traits (e.g., self-regulatory capacities), characteristics of the abuse (e.g., duration), exposure to multiple forms of violence (both within and outside the home), as well as parenting and familial resources (e.g., parents’ mental health and abuse history, familial social support). Two of the articles focus on dual victimization in the home, two address factors that modify the relation between child sexual abuse and adjustment, and the last two articles focus on mediators of the relationship between abuse or exposure to IPV and adjustment. Taken together, these articles reflect efforts at elucidating modifiable targets for prevention and intervention purposes, as well as qualities of the individual, family, or the abuse that may aid in tailoring interventions to be maximally effective.     

Are Children with Disabilities and Long-term Illnesses at Increased Risk of Disciplinary Violence?

This study examined the association between disability status and the risk of disciplinary violence at the hands of parents. The data consist of a nationally representative sample of 12–13 and 15–16-year-old Finnish school children (n = 13,459). These representative data were collected by the Police College of Finland. The results show that having a visual impairment, mental health problems, learning and/or memory difficulties, or another chronic illness, such as asthma, is associated with an increased risk of disciplinary violence. Children with multiple disabilities were significantly more likely to be targets of disciplinary violence. These findings suggest that children with disabilities are particularly vulnerable to maltreatment.