Risk,response, and mental health policy: learning from the experience of the United Kingdom

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.     

Comparison of MMPI psychopathic deviate scores of battered and nonbattered women

Despite the voluminous research using the Minnesota Multiphasic Personality Inventory, little research has been done evaluating the MMPI for assessing personality profiles and psychopathology in victims of domestic violence. The current study focused on the Psychopathic Deviate scale (scale 4), and the Harris and Lingoes subscales measuring specific aspects of this concept. The objective was to evaluate whether a clinical population of battered women differed from a nonbattered group drawn from a similar clinical setting. The battered group scored higher on the full scale (p .001), the Authority Problems scale (p .001), the Social Alienation scale, (p .01), and the Social Imperturbability scale (p .05). There was no difference on Self-Alienation. The score on Family Discord (Pd1) was the most elevated for the battered group, falling just below moderately elevated. Within the battered group, the score on Family Discord (M =69.11) was significantly more highly elevated than the score on Self-Alienation (M =60.4) (the next most highly elevated score). These findings suggest that there is an association between elevated scale 4 scores and victimization by domestic violence. However, it is essential that clinicians carefully evaluate such scores in the context of each individual situation before attributing causation.