The statistical prediction of violent behavior

Considerable attention in the popular and professional literature has focused on the relative costs and benefits of using public protectionist versus civil libertarian models of social control. In this article, we develop statistical analogs of these models to predict violent behavior among samples of defendants found incompetent to stand trial in New York State. The societal and personal costs (errors of prediction) of each model are compared and their implications for clinical practice and social policy are discussed.This research was supported in part by PHS Grant MH 20367 from the NIMH Center for Studies of Crime and Delinquency. The assistance of Thomas Arvanites in data analysis and the comments of Monroe Lefkowitz and Mary Evans Melick on earlier drafts of this paper are gratefully acknowledged.     

Factors predicting selection of sexually violent predators for civil commitment

This study investigated the degree to which independent variables predicted civil commitment selection in a sample of 450 sexual offenders evaluated for civil commitment as "sexually violent predators" under Florida's Jimmy Ryce Act. Using logistic regression, this study examined the relationship between the dependent variable, commitment recommendation, and several sets of independent variables. Results revealed that the statistically significant predictors of recommendations for sex offender civil commitment were diagnoses of pedophilia and paraphilia not otherwise specified (NOS), psychopathy, actuarial risk assessment scores, younger age of victim, and nonminority race (R2 = .88). Discriminant function analysis confirmed that these variables correctly predicted commitment recommendations in 90% of cases. Sex offenders recommended for commitment consistently met the criteria set forth by the U.S. Supreme Court in Kansas v. Hendricks (1997): They suffered from a mental abnormality predisposing them to sexual violence, and risk assessment determined that they were likely to reoffend.     

The structure of civil commitment

The contents and provisions of civil commitment codes are shaped by a number of influences. This article examines those influences and categorizes them as either falling within the civil commitment system itself or as being external to that system. From an analysis of those internal and external influences, it is concluded that the structure of civil commitment is very much dependent upon the environment in which such laws operate and upon the intricate and integral relationship between civil commitment and other important forms of mental health legislation (incompetence to stand trial, the insanity defense, etc.).     

The utility of extended outpatient civil commitment

OBJECTIVE: This study considers three hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization. METHOD: Service utilization of Victorian Psychiatric Case Register (VPCR) patients with extended (> or =180 day) outpatient commitment orders was compared to that of a diagnostically-matched treatment compliant group with similarly extended (> or =180 day) periods of outpatient care (N=1182)--the former receiving care during their extended episode on an involuntary basis while the latter participated in care voluntarily. Pre/post first extended episode mental health service utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences. RESULTS: Extended episodes of care for both groups were associated with subsequent reduced use of hospitalization and increases in community treatment days. Extended orders did not promote voluntary participation in the period following their termination. Community treatment days during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group during their extended episode and maintained at that level via subsequent renewal of orders throughout the patients' careers. Approximately six community treatment days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode. CONCLUSION: Outpatient commitment for those on extended orders in the Victorian context enabled a level of community-based treatment provision unexpected in the absence of this delivery system and provided an alternative to hospitalization.     

Outpatient civil commitment in Texas for management and treatment of sexually violent predators: a preliminary report

Texas established in 1999 outpatient civil commitment for sexually violent predators discharged from prison with or without parole. These individuals suffer from a behavioral abnormality, have been convicted of two or more sexually violent crimes and are deemed likely to reoffend. Civilly committed individuals are managed by a team composed of case manager (supervision), treatment provider, public safety officer (global positioning satellite monitoring), and other professionals. Treatment consists of individual and group therapy using a standard workbook. Out of 21 committed individuals, 7 are in the treatment, 1 died, 10 are in custody after breaking conditions of commitment that constitute a felony, and 3 await release from prison. Cost of outpatient civil commitment is less than $20,000/person/year compared with more than $100,000 for inpatient commitment in other states. Texas has found outpatient civil commitment to be an effective and relatively low-cost way to protect the public and treat the offender.     

Suicide and civil commitment

The contemporary approach to suicide prevention relies primarily on involuntary commitment of the suicidal individual. While there is generally widespread acceptance of the principle of society's right, even its moral obligation, to intervene to prevent a suicide, there is much less agreement concerning the conditions under which such an action should proceed. Most of the debate centers on the widely applied commitment criteria of mental illness and dangerousness to self and others. Questions have also been raised regarding the efficacy of commitment as a preventive measure. In this paper, these controversies are placed in a broader historical context. We examine empirical evidence concerning prevailing commitment criteria and the prophylactic value of involuntary hospitalization, and discuss the appropriateness of our current approach to civil commitment in light of existing data.     

Dangerousness of civil commitment candidates

This study followed a large, statewide sample of civil commitment candidates both in and out of the hospital for 6 months following their postcourt hearings to determine their postcourt dangerousness. It objectively measures dangerousness by dividing it into five legal components of behavior: (1) type, (2) object, (3) frequency, (4) weapon/means, and (5) severity of outcome. Using data from ward charts, readmission evaluations, recommitment affidavits, and arrest and community mental health center records, it describes candidates' dangerousness in terms of those, five components and compares that dangerousness with the alleged dangerous behavior that brought them into the civil commitment process. It finds that candidates do not tend to be dangerous in the 6 months following their court hearings.     

Strategies for an empirical analysis of the prediction of violence in emergency civil commitment

Dix (1976) recently has proposed that a “true experiment” be conducted to assess the validity of predictions of imminent violence. A random sample of persons predicted to be iminently violent would be denied emergency civil commitment in order to test whether they do, in fact, commit a violent act. This article analyzes Dix's proposal and finds that it presents an unacceptable level of risk to the community. Four alternative methodologies by which preliminary data can be gathered on the validity of predictions of violence in emergency civil commitment are described.     

Outpatient civil commitment: a dangerous charade or a component of a comprehensive institution of civil commitment?

This article examines three criticisms frequently directed toward preventive commitment as one form of outpatient commitment. These criticisms contend that preventive commitment (a) abandons the dangerousness criteria for civil commitmnet, (b) promotes unwarranted inpatient commitment of those who do not meet civil commitment criteria, and (c) undermines important individual liberties by diluting the right to refuse treatment. Understanding and evaluating these criticisms requires analysis of the intersection among empirical, conceptual, and justificatory claims. According to the analysis presented here, advocates of preventive commitment can defend a legitimate role for preventive commitment. This analysis applies to preventive commitment as a dispositional alternative within a comprehensive institution of civil commitment involving distinct parens patriae and police power components.     

Characteristics of individuals petitioned for civil commitment

This article explores the demographic and criminal characteristics of a group of sex offenders currently residing in a facility for civilly committed sex offenders. Legal and clinical records were used and data coded. This sample is compared to published data on a group of civilly committed sex offenders in another state. Results indicated that there were numerous similarities and some differences between the two groups. Further research needs to be conducted on civilly committed sex offenders in other states to better understand this population.