The results indicate that a mental health court can reduce recidivism and violence by people with mental disorders who are involved in the criminal justice system.

People who were homeless and who were identified as having mental disorders, although representing only a small proportion of the total population, accounted for a substantial proportion of persons who were incarcerated in the criminal justice system in this study's urban setting. The increased duration of incarceration associated with homelessness and co-occurring severe mental disorders and substance-related disorders suggests that jails are de facto assuming responsibility for a population whose needs span multiple service delivery systems.

Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system.

The authors evaluated the utility of 3 decision support tools for assessing acute risk of violence in patients undergoing behavioral emergencies that warranted hospitalization. Information available at the time of admission to a short-term psychiatric unit was coded from the medical charts of 100 patients using the Historical, Clinical, Risk Management-20 (HCR-20), the Hare Psychopathy Checklist-Screening Version (PCL-SV), and the McNiel-Binder Violence Screening Checklist (VSC). Nurses rated violence that later occurred during hospitalization with the Overt Aggression Scale. Scores on all 3 instruments were associated with the likelihood of violence. The strongest predictive relationships were obtained for indices of clinical risk factors rather than historical risk factors. The results suggest that decision support tools, particularly those that emphasize clinical risk factors, have the potential to improve decision making about violence risk in the context of behavioral emergencies.

A screening checklist for assessing the risk of violence at the time of psychiatric hospitalization was developed. Checklist items and a cutoff point for low versus high risk of violence were selected based on a previous study of statistical prediction of violence. Application of the checklist to a new sample of 338 patients admitted to a university-based inpatient unit revealed promising results in identifying patients who later displayed aggressive behavior in the hospital, as indicated by its positive predictive value (59.0%), negative predictive value (70.6%), sensitivity (57.2%), specificity (70.0%), total predictive value (65.4%), and likelihood ratio (1.97). The results suggest the potential value of incorporating actuarial methods in the evaluation of violence risk.Although evaluations of violence potential are frequent components of clinical practice in emergency and inpatient psychiatric settings, the limitations of clinicians' abilities in assessing violence potential are well known (Monahan, 1981). Several authors have suggested that evaluations of violence potential could be

The authors propose a new theoretical construct for understanding the risk of violent behavior by psychiatric patients: the aggressive attributional style. They propose that a cognitive style characterized by external hostile attributions increases the risk of violence by mentally ill persons. To evaluate this hypothesis, they administered several self-report measures relevant to the aggressive cognitive style, as well as measures of violent behavior in the community, to 110 psychiatric inpatients. Higher scores on several indicators of the aggressive attributional style were associated with violence. Multivariate logistic regression analyses showed that the relationship between attributional style and violence held up when demographic and diagnostic characteristics and impulsiveness were controlled. The authors discuss implications for development of cognitive interventions to reduce violence risk.

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