Violent behavior and the factors associated with the decision to report it: a retrospective study

An ample volume of research evidence supports the conclusion that severe mental illness is correlated with violent behavior. While episodes of violent behavior are included in medical notes, not all episodes of violent behavior are officially reported to the police, even when they are actual crimes. We conducted a retrospective study on the already existing clinical files of four public psychiatric outpatient facilities, based in Southern Italy, in order to assess how many cases of violent behavior are actually reported and which variables are more frequently connected with the decision to report. The data shows that the episodes known to the health services, in number and seriousness, vastly outnumber the complaints actually made towards their patients.     

Domestically and generally violent forensic psychiatric outpatients: personality traits and behavior

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.     

Violence in geriatric patients with dementia

Although the elderly have been studied as victims of violent behavior, there has been little investigation of this population as perpetrators of violence. Using the method of retrospective chart review, this study examines the issue of violence by geriatric patients with dementia who need acute psychiatric hospitalization. Of 52 patients, 44 percent engaged in physical attacks and/or fear-inducing behavior during the two weeks prior to admission, and 29 percent engaged in similar behavior within the first 72 hours of hospitalization. Married patients and those who lived with family were overrepresented in the group of violent patients. The authors discuss possible explanations and implications of these findings.     

A prospective study of predictors of violence in adult male mental health admissions

Studies of violence prediction have typically involved long-range follow-up of institutionalized persons and have shown poor predictive accuracy. In the present study a sample of adult males at risk for violent behavior admitted as inpatients at a community mental health center was followed for six months after their release. Data collected at admission (which included demographics, family back-ground, criminal justice and mental health systems contacts, past violent behavior, life stress, family, friendship, and work environment measures, psychiatric diagnosis, and alcohol and drug use) were used to predict subsequent violent arrests or readmissions using stepwise discriminant analysis. Results yielded 85% of the total sample correctly classified. Of those predicted to be nonviolent 94% were actually nonviolent and of those predicted to be violen 59% were actually violent. Seventy-six percent of the violent subjects were identified. Implications of the findings for clinical predictions of violence are discussed.     

The precarious practice of forensic psychiatric risk assessments

The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.     

Predicting violence among forensic-correctional populations: the past 2 decades of advancements and future endeavors

Research on violence prediction during the past 2 decades has evolved appreciably in terms of depicting determinants of violence and developing psychometrically sound actuarial measures to predict the probability of future violent behavior. This article provides a brief synopsis of information on predicting violence gained in the past 2 decades, the methodological advances evolved, and finally significant gaps in violence prediction that still exist for future research endeavors.     

Assessment and training of social competence in dangerous psychiatric patients

Traditional approaches to the assessment and treatment of individuals who have demonstrated dangerous behavior have been based upon a trait model of personality. The social competence model differs from the trait model by assuming that much behavior is situationally determined, that new socially competent behavior patterns can be acquired through observation of models and practice, and that the frequency of undesirable behaviors can be reduced by increasing the frequency of incompatible, desirable behaviors. This paper reports the applications of the social competence model to the assessment and treatment of men in a security hospital, including individuals confined because of specific offenses, such as sex crimes, arson, and institutional assault, as well as those with high overcontrolled-hostility scores, low overall social skill ratings, and low popularity ratings from their peers. The social skills training approach that we have employed has been most successful with sex offenders and arsonists. The results suggest that the most withdrawn and shy individuals derive the greatest benefit from our social skills training approach while overassertive individuals benefit least. It is hypothesized that staff may reward unassertive patient behavior and punish assertive behavior and that future research must focus on changing this pattern in order to foster socially competent behavior by institutional residents. While many problems remain to be answered, our preliminary results suggest the usefulness of the social competence approach in the assessment and treatment of dangerous psychiatric patients and offer the possibility that the approach may lead to better control of violent behavior in the future.     

Violent girls in adolescent forensic care are more often psychotic and traumatized than boys in the same level of care

Background: Most research on violent perpetrators is based on male samples. Aims: To compare girls and boys admitted to an adolescent forensic unit due to physically violent and/or sexually coercive behavior. Methods: On an adolescent forensic ward, demographics, family, treatment, crime and victimization histories, diagnose, psychiatric symptoms and violent behaviors during care of all adolescents are collected in a cumulative database. These were compared between girls and boys admitted due to violent behaviors. Results: Girls were more often diagnosed with schizophrenia group psychoses. The symptom profiles and violence risk ratings did not differ by sex. The girls were less antisocial in general. They were more suicidal and displayed more promiscuous behaviors, and they had more commonly been victims of sexual abuse. During inpatient care they displayed much more often violent and uncontrollable behaviors than the boys. Conclusion: Treatment approaches that respond to the special needs of aggressive girls are required.     

Empathy as a predictor of recidivism among young adult offenders

This longitudinal study examined the role of empathy in predicting recidivism among young adult offenders. During their prison terms, 748 male offenders between the ages of 15 and 28 were administered the interpersonal reactivity index (IRI; Davis, 1980). Official criminal records were used to determine general as well as violent recidivism during the (on average) five years following release from prison. Cox regression models of reoffense rates were calculated using IRI scales as explanatory variables while controlling for age, socioeconomic status, duration of imprisonment, and intelligence. The global empathy score and the subscales of perspective taking and empathic fantasy, but neither empathic concern nor personal distress, contributed to the prediction of recidivism. Furthermore, empathy did not contribute significantly to the prediction of violent reoffending. However, comparing offenders whose index crimes were violent versus nonviolent, violent offenders scored lower on the IRI and recidivated more often with a violent offence than did nonviolent offenders.     

The Role of Vicarious and Anticipated Strain on the Overlap of Violent Perpetration and Victimization: A Test of General Strain Theory

Numerous studies have documented a relationship between criminal offending and violent victimization. That is, people who commit criminal behavior are also more likely to be victimized. As such, criminological theories traditionally used to explain criminal behavior have now been applied to explain victimization. The current study examines whether Agnew’s general strain theory can explain the offender-victim overlap using a nationally representative sample of males. Results show that vicarious strain is positive and significant in predicting both victimization and perpetration. Anticipated strain was found only to be significant and positive in predicting victimization, but not perpetration. The study’s limitations and future research are discussed.     

A comparison of actuarial methods for identifying repetitively violent patients with mental Illnesses

This is a progress report on the development of practical methods for the actuarial prediction of violence. The literature indicates that actuarial prediction is more accurate than clinical prediction, but in practice actuarial methods seem to be used rarely. Here we address two obstacles to the clinical use of actuarial prediction methods. First, clinicians may be averse to actuarial methods that require calculations. To remedy this, we developed a regression tree screen that presents actuarial information about violence in a series of yes/no questions. Second, using actuarial methods to identify the small minority of violent patients in a general psychiatric population may be too costly. To remedy this, we developed a method to prescreen patients for intensive evaluation using an inexpensive assessment. We evaluated regression trees and two-stage screening by comparing their accuracies against conventional actuarial methods. The results showed that actuarial predictions based on regression trees and two-stage screens were as accurate as regression-based methods in identifying repetitively violent patients. These easier-to-use methods may therefore be useful techniques for actuarial predictions.     

Prison behavior and the victim-offender relationship among violent offenders

This research explores the role of the victim-offender relationship of prison inmates' commitment crimes in predicting violent offenders' behavior problems. The importance of the victim-offender relationship is supported by anecdotal accounts and theoretical reasoning which suggest that nonstranger offenders have fewer disciplinary problems in prison than stranger offenders. Inmate interviews and official data were collected from 273 violent offenders. Results suggest that inmates with more extensive rule-breaking behaviors are likely to be younger, less intelligent individuals who victimize strangers, have had more numerous juvenile convictions, and have served at least one prior prison term. Conclusions and implications for public policy are discussed.     

Violent criminals locked up: Examining the effect of incarceration on behavioral continuity

Purpose

The purpose of the current study was to determine whether, and the degree to which, inmates committing specific types of violent crimes in the community were prone to commit acts of violence while incarcerated.

Materials and methods

Data were collected from the Texas Department of Criminal Justice on the prison stock population and a restricted admissions cohort serving time during FY 2008.

Results

After controlling for pre-prison and post-conviction characteristics, crime of conviction retained a modest degree of influence on inmates’ propensity to commit dangerous rule violations in prison. Inmates convicted of assault, robbery and other miscellaneous violent crimes were more likely to commit dangerous rule infractions than inmates convicted of property crimes, supporting the behavioral continuity thesis. Inmates convicted of homicide were no more likely, and those convicted of sexual assault less likely, to commit dangerous rule violations in comparison to those convicted of property crimes.

Conclusions

The findings suggest that researchers and prison officials should not view all inmates convicted of one of a broad category of “violent crimes” in the community as being equivalent in their propensity for violence while incarcerated.     

Female juvenile murderers: Biological and psychological dynamics leading to homicide

The increasing involvement of girls under 18 in violent crime has been a matter of growing concern in the United States in recent years. This article reviews the arrests of female juveniles for violent crime and then focuses specifically on their involvement in homicide. Arrests of girls for murder, unlike arrests for assault, have not risen over the last 30 years, suggesting that the dynamics that propel female juveniles to engage in lethal violence differ from those contributing to assaultive behavior by this same group. A review of the literature indicates that theories as to why female adolescents kill do not take into account recent scientific findings on brain development and the biological effects of early trauma in explaining serious violent behavior by girls. Three cases, evaluated by the authors, involving female adolescents charged with murder or attempted murder, are presented. The authors focus on the biological and psychological dynamics that help explain their violent behavior. They discuss the effects of insecure attachment and child maltreatment, and trace a critical pathway between these early experiences and future risk of violent behavior. The dynamics of child maltreatment in fostering rage and violence are discussed thereafter in terms of offender accountability. The article concludes with a discussion of treatment and recommendations for future research.     

Specifying the role of exposure to violence and violent behavior on initiation of gun carrying: a longitudinal test of three models of youth gun carrying

Two waves of longitudinal data from 1,049 African American youth living in extreme poverty are used to examine the impact of exposure to violence (Time 1) and violent behavior (Time 1) on first time gun carrying (Time 2). Multivariate logistic regression results indicate that (a) violent behavior (Time 1) increased the likelihood of initiation of gun carrying (Time 2) by 76% after controlling for exposure to violence at Time 1, which is consistent with the stepping stone model of youth gun carrying, and (b) youth who were both exposed to violence at Time 1 and engaged in violent behavior at Time 1 were more than 2.5 times more likely to initiate gun carrying at Time 2 compared to youth who had neither of these characteristics, which supports the cumulative risk model of youth gun carrying. The authors discuss the implications of these findings in clarifying the role of violence in the community on youth gun carrying and the primary prevention of youth gun violence.     

Can we keep it simple? Using the BARR-2002R with a community-based sex offender sample

The Brief Assessment of Recidivism Risk (BARR-2002R) comprises of six items from the Static-2002R and has been designed for predicting general and violent recidivism among sexual offenders. The present study investigates the ability of the BARR-2002R, Static-2002R, Static-99R, and SORAG to predict general, violent, and sexual recidivism in a sample of 342 male sex offenders at a community-based forensic clinic. All four of the risk schemes demonstrated large effect sizes for predicting general, violent, and sexual recidivism, although the BARR-2002R produced a moderate effect size in its prediction of sexual reoffending. Unlike past research, the BARR-2002R did not outperform the other measures; however, our findings showed that the BARR-2002R adds incremental value to the Static-99R in predicting general and violent recidivism. These findings provide support that the BARR-2002R is a valid, abbreviated risk scheme that could be used in routine assessments of individuals convicted of sexual offending.     

TRENDS IN VIOLENT CRIME AMONG EX-MENTAL PATIENTS

A central component of the public's conception of the mentally ill is that they are dangerous. This belief receives support from recent studies of the arrest rates of ex-mental patients which suggest that arrests for violent crimes have increased. In order to investigate this issue, samples were taken at two points in time. Analysis of arrest rates revealed that very few ex-mental patients were subsequently arrested for violent crimes, although these rates were higher and increasing faster than these of the general population. Mast significant were the findings that subsequent arrests were best explained by the number of prior arrests and that the percentage of patients with a history of criminal behavior has increased dramatically over time. The implications of these trends in violent crime among ex-mental patients for the perceived link between mental illness and violence and for the social control functions of society are discussed.     

Stigma and discrimination in mentally disordered offender patients – a comparison with a non-forensic population

High levels of stigma and discrimination are reported by individuals with mental health problems. Aim: To assess self-reported levels of stigma and discrimination in forensic psychiatric patients, with psychotic illness, compared with general adult psychiatric patients with psychosis. Hypothesis: Individuals with a history of violent offending, as well as severe mental illness, report more stigma and discrimination, than non offender patients, as a result of them being perceived as dangerous and unpredictable. Method: Experiences of stigma and discrimination were compared in 32 forensic and 32 non-forensic general psychiatric patients, with schizophrenia or schizoaffective disorder, using the Stigma and Discrimination Scale (DISC). Results: Stigma and discrimination were widely reported by all patients, particularly affecting relationships with family, intimate relationships and friendships. No significant difference emerged between the forensic and non-forensic patients, in experienced or anticipated stigma. Conclusions: We suggest that the lower level of psycho pathology, longer inpatient stays and intensive rehabilitation for forensic patients may reduce the extent to which these patients experience stigma and discrimination.     

Prospective Replication of the Violence Risk Appraisal Guide in Predicting Violent Recidivism Among Forensic Patients

An exhaustive survey of a cohort of forensic patients provided an opportunity for a prospective replication of the predictive accuracy of the Violence Risk Appraisal Guide (VRAG). Data collected during the original survey also permitted a test of the predictive accuracy of clinical assessments of risk on the same cohort. The VRAG yielded a large effect size in predicting violent recidivism (ROC area = .80) over a constant 5-year follow-up and performed significantly better than averaged clinical opinions. The superiority of the VRAG was also observed at very short follow-up times and for very serious violence. Moreover, for 16 subsamples, observed rates of violent recidivism did not differ significantly from the expected rates. VRAG score was unrelated, and clinical judgments inversely related to violent recidivism in the small low-risk sample of female forensic patients. The authors conclude that, regardless of length of opportunity or severity of outcome, actuarial methods are more accurate than is clinical judgment.