Violence Risk Assessment and Risk Communication: The Effects of Using Actual Cases,Providing Instruction,and Employing Probability Versus Frequency Formats

This article describes studies designed to inform policy makers and practitioners about factors influencing the validity of violence risk assessment and risk communication. Forensic psychologists and psychiatrists were shown case summaries of patients hospitalized with mental disorder and were asked to judge the likelihood that the patient would harm someone within six months after discharge from the hospital. They also judged whether the patient posed a high risk, medium risk, or low risk of harming someone after discharge. Studies 1 and 2 replicated, with real case summaries as stimuli, the response-scale effects found by Slovic and Monahan (1995). Providing clinicians with response scales allowing more discriminability among smaller probabilities led patients to be judged as posing lower probabilities of committing harmful acts. This format effect was not eliminated by having clinicians judge relative frequencies rather than probabilities or by providing them with instruction in how to make these types of judgments. In addition, frequency scales led to lower mean likelihood judgments than did probability scales, but, at any given level of likelihood, a patient was judged as posing higher risk if that likelihood was derived from a frequency scale (e.g., 10 out of 100) than if it was derived from a probability scale (e.g., 10%). Similarly, communicating a patient's dangerousness as a relative frequency (e.g., 2 out of 10) led to much higher perceived risk than did communicating a comparable probability (e.g., 20%). The different reactions to probability and frequency formats appear to be attributable to the more frightening images evoked by frequencies. Implications for risk assessment and risk communication are discussed.     

论共同犯罪的转化犯

转化犯是真正身份犯。在聚众斗殴过程中出现致人伤亡但无法查清行为人情形的,应当根据行为人事前对伤亡结果的心理态度确定是否构成转化犯罪及其责任范围;集团犯罪转化犯的责任范围应当根据行为人事前对暴力、胁迫行为的心理态度来确定。间接正犯的转化犯要根据利用者对法定结果的心理态度和被利用者刑事责任能力的状态来确定;共谋共同正犯转化犯的责任范围应当根据共谋的内容是否包括转化犯罪来确定;承继性共同正犯转化犯的责任范围应当根据后参与者参加犯罪的时间来确定。在共同犯罪的转化犯与结果加重犯竞合的情况下,需要根据转化犯罪的性质来确定转化犯的责任范围;在共同犯罪的转化犯与包容犯发生竞合的情况下,应当根据行为人的行为状态来确定转化犯的责任范围。     

Coercion and patient satisfaction on psychiatric acute wards

Legal-, perceived- and objective coercion were examined both separately and together as a measure of accumulated coercion, to determine how coercion affected patient satisfaction in patients admitted for acute psychiatric care. Accumulated coercive events significantly reduced both overall satisfaction, and satisfaction in four of five subscales evaluating different aspects of treatment. Neither legal status nor perceived coercion affected patient satisfaction, while objective coercion had a significant negative effect on overall satisfaction when these measures were analysed separately. Overall patient satisfaction reported at discharge was low, while satisfaction with different aspects of treatment showed considerable variation. The observation that perceived coercion in the admission process did not affect satisfaction significantly underlines the need to further explore the interaction between subjective and objective measures for coercion. It appears that multiple measures for coercion should be used in future studies.     

Coercion,competence, and consent in offenders with personality disorder

Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale – Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.     

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.     

Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

Outpatient commitment and coercion in New Zealand: a matched comparison study

BACKGROUND: It has been hypothesized that a degree of coercion is a necessary component in using outpatient commitment to attain therapeutic outcome for those people subject to mental health law. However, what degree of coercion is required and how it is sustained is poorly understood. There is speculation that patients' recognition of beneficial as well as unwanted aspects of outpatient commitment (ambivalence) maybe an indicator that the necessary level of coercion has been achieved to facilitate a therapeutic outcome. AIM: The aim of this study was to determine the level of coercion perceived by those under outpatient commitment in New Zealand. Emphasis was given to consideration of the presence of ambivalence and the role of interactive processes, including procedural justice, in influencing patients' perceptions of coercion. METHOD: A cross-sectional comparative study was undertaken to compare the perceptions of coercion of patients on outpatient commitment (n = 69) to a matched sample of voluntary outpatients (n = 69), using the Perceived Coercion Scale. The influence of a range of variables, including patients' knowledge of and beliefs concerning outpatient commitment, were considered. RESULTS: Although the level of coercion for involuntary outpatients was relatively low, it was significantly higher than that experienced by voluntary outpatients. Yet involuntary outpatients were more likely to espouse benefits of outpatient commitment. Although there was an inverse correlation between perceptions of procedural justice and perceived coercion, procedural justice did not feature in the linear regression analysis. DISCUSSION: In the New Zealand context, involuntary outpatients hold contrasting views to outpatient commitment. We suggest that this ambivalence is an indicator that the degree of coercion is suffice to achieve therapeutic outcome. Furthermore, this study suggests the impact of procedural justice on patients' perceptions of coercion may be more crucial during admission to hospital than in the context of on-going community care.     

Attitudes among stakeholders towards compulsory mental health care in Norway

Objectives

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. Even though the current practice has been criticized, little empirical data exist about the attitudes towards compulsory mental health care.

Method

This study used Q-methodology to identify prototypical attitudes and to test possible differences of attitudes between groups of stakeholders towards the use of coercion in mental health care. Sixty-two respondents who represented six groups with different roles in mental health care participated: former patients, relatives of psychiatric patients, members of supervisory commissions, psychiatrists, other physicians, and lawyers.The participants were asked to assess the degree to which they agreed on 30 statements concerning use of coercion for the mentally ill.

Results

Three factors that in a meaningful way express different attitudes towards the question were found. The most widely shared attitude stated that a trusting relationship between patient and therapist is more important than the right to have an attorney. This attitude gives partial support to the present Mental Health Care Act. However, the second most common attitude argues that involuntary hospitalization, if necessary, should be decided in a court and not by the hospital doctor.

Conclusions

Differences in attitude could partly be explained by the respondents' role in mental health care. Both psychiatrists and “somatic” physicians expressed more agreement with the present legislation than the other stakeholders. The findings may have implications for the legal protection of mental health care patients.     

Sex-symmetric effects of coercive behaviors on mental health? Not exactly

The present study tested a section of the model of coercion in intimate partner violence (IPV) by investigating the relationships among coercion, IPV and mental health symptoms. The study's sample consisted of 573 culturally diverse university students (age M = 21.4) who completed a survey that measured past IPV victimization, coercive behaviors, and mental health symptoms. Structural equation modeling analyses revealed that coercion was a stronger predictor of adverse mental health symptoms than was IPV victimization. In addition, the study found that the adverse effect of coercive behaviors on mental health symptoms was stronger among female victims of IPV than among male IPV victims. The results have implications for theory building, future research, and mental health professionals who work with female and male victims of IPV.     

The Forces of Law: Duty,Coercion, and Power

This paper addresses the relationship between law and coercive force. It defends, against Frederick Schauer's contrary claims, the following propositions: (a) The force of law consists in three things, not one: the imposition of duties, the use of coercion, and the exercise of social power. These are different and distinct. (b) Even if coercion is not part of the concept of law, coercion is connected to law many important ways, and these are amply recognized in contemporary analytic jurisprudence. (c) We cannot determine how important coercion is to the efficacy of law until we know what counts as coercive force. The question of what counts as coercion is not a matter for generalization or stipulation. It requires an explanation of the concept of coercion.     

The relationship between adverse childhood experiences,coping using sex,and adult sexual coercion in non-incarcerated,community-based females

ABSTRACT

Adverse childhood experiences have been associated with negative outcomes in adulthood, including sexual offending. Using a cross-sectional design, we investigated whether self-reported adverse childhood experiences related to the perpetration of coercive sexual acts among 250 females recruited from the community. Furthermore, we examined whether sexualised coping mediated any potential relationship between childhood experiences and sexual coercion. A Spearman’s rank order correlation revealed no relationship between adverse childhood experiences and sexual coercion. However, adverse childhood experiences were significantly correlated with sexualised coping, which in turn was correlated with sexual coercion. Additionally, there was a significant but small indirect effect of adverse childhood experiences on sexual coercion through sexualised coping. Findings may help researchers to better understand the causal relationship between childhood experiences, sexual coping, and sexual coercion in females.     

Sociodemographic,Clinical, and Therapeutic Aspects of Penitentiary Psychiatric Consultation: Toward Integration Into the General Mental Health Services

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.     

Sex offender treatment is not punishment

Abstract

The treatment of sexual offenders can be fraught with ethical dilemmas. Practitioners must balance the therapeutic needs of sex offender clients alongside the risks they might pose to others. These ethical challenges include balancing community safety with the rights of the offender, the privileged therapeutic relationship and the potential for coerced treatment. In this paper, we respond to Glaser's argument that treatment is punishment and that sex offender treatment providers breach ethical codes by violating confidentiality, engaging in coercion, and ultimately causing harm to clients. We first consider whether sex offender treatment is indeed punishment. We argue that it is not, and that mandated treatment can and should be conducted in a fashion consistent with professional codes of ethics familiar to mental health providers. We then discuss the human rights model, which we agree is an essential lens through which to view the psychological treatment of sexual offenders. We attempt, as have other scholars, to illustrate the ways in which human rights principles intersect with traditional mental health codes of ethics particularly in the case of sex offender treatment. We conclude that sex offender treatment can be conducted ethically, that treatment differs from punishment in clear and distinct ways, and that ethical treatment conforms to a human rights perspective.     

Why Is There a Strong Positive Correlation Between Perpetration and Being a Victim of Sexual Coercion? An Exploratory Study

The purpose of this research was to determine if the correlation between perpetration and being a victim of sexual coercion is due to a lack of self-control, a coercive lifestyle, or dysfunctional romantic relationships. Two hundred and sixty-two college students completed measures of perpetration and being a victim of sexual coercion, lack of self-control, coercive lifestyle, romantic partner’s coercive lifestyle, and partner’s perpetration and being a victim of sexual coercion. Support was not found for the lack of self-control and coercive lifestyle explanations; support was found for the dysfunctional relationships explanation. Multiple regression analyses found that the self-control variable that best (negatively) predicted both perpetration and being a victim of sexual coercion was valuing long-term, committed romantic relationships. Interventions to prevent perpetration and being a victim of sexual coercion should focus not only on the individual victim/perpetrator but also on promoting functional romantic relationships.     

The Effect of Coercion on Aggression and Mental Health Among Reciprocally Violent Couples

Researchers have not investigated mental health outcomes among couples who are reciprocally violent towards each other. The present study investigated differences in partner violence (psychological, physical, and sexual) and mental health symptoms (depression, anxiety, hostility, and somatic) between two types of reciprocally violent couples: situational couple violence (SCV) and mutual control violence (MVC). SCV couples use violence to address stressful family conflicts, while MVC couples use violence as a tool to control each other. Participants (N = 609) completed surveys that contained several instruments that measured past violence, coercive behaviors, physical injuries, and mental health symptoms. Results revealed that MVC reported significantly higher levels of violent perpetration and worse physical and mental health than SCV. These findings have implications for understanding the role of coercion in partner violence and mental health, which can be used for the development of appropriate mental health services for couples who are mutually violent towards each other.     

英美刑法辩护理由中的“胁迫”及其启示

胁迫是英美法系各国刑法普遍承认的一种犯罪辩护理由。传统意义的胁迫是指胁迫者以紧迫的死亡或严重伤害身体相威胁,迫使行为人实施某种被刑法禁止的行为。胁迫是一种犯罪的可宽恕事由,其根据在于,当一个人面临一般人都无法抗拒的严重威胁,主观上难以作出合法的选择时,缺乏刑事归责的可能性。我国刑法中没有胁迫的概念,司法中按照紧急避险处理被胁迫犯罪案件,这既不符合被胁迫犯罪的本质,也限制了胁迫的适用范围。我国刑法应当引入胁迫的概念,将其视为一种独立的阻却责任事由。我国刑法对胁迫的适用,应当采取形式与实质相结合的标准。胁迫不能适用于故意杀人犯罪。     

Professional attitudes regarding treatment and punishment of incest: Comparing police,child welfare,and community mental health

Brief case histories involving incest were presented to police officers, child welfare workers, and community mental health practitioners in a rural area in Canada. Intervention priorities involving “treatment versus punishment” were assessed across the three professional groups for each specific case vignette. Attitudes were assessed on three factors: perpetrator mentally ill rather than criminal, view regarding treatment of victims and mothers, and support for court mandated treatment. Police and community mental health practitioners had significantly different attitudes as to whether perpetrators of child sexual abuse should be viewed more as criminals or as mentally disturbed. Both mental health and child welfare staff differed significantly from police with a less punitive view towards victims and their mothers. All three profressional groups showed no difference in their modest endorsement of the use of mandated treatment by the courts. Gender was not found to influence response to case vignettes.