Dangerousness and violence in hospitalized mentally ill offenders

Abstract

Clinical judgments of dangerousness depend not only on patient characteristics, but are greatly influenced by the perspective of the rater and the context for which the assessments are made. Similarly, institutional violence is determined not only by patient characteristics, but is also a function of contextual variables such as physical milieu, important clinical events not under the control of the patient, etc. To increase the predictive validity of assessments of dangerousness it is essential to specify the vulnerabilities and strengths of the patient, the current life stressors, and the contextual triggers to which the patient is likely to react violently. The momentary contextual triggers may be useful to predict the type and severity of violence and perhaps the most likely victims as well. Analyses of previous violent incidents may provide markers for contextual triggers, e.g., type of weapon, victim, severity of violence, etc.

The violence relapse process – a qualitative analysis of high-risk situations and risk communication in mentally disordered offenders

“…Stokman (1984) and Morrison (1994) have addressed the complex relationship between the individual and the environment. Stokman states (1984, p. 139), ''A violent act is the end result of an interaction between a person, who is in a state of dangerousness, and the environment, which provides the opportunity and triggers for violence''.…”

‘Dangerous and severe personality disorder’: A psychiatric manifestation of the risk society

“…In a meta-analysis of the studies on the topic of violence and the mentally disordered (from different sources and from different perspectives), Monahan (1984) concludes that there is a limited connection between mental disorder and violence. Whilst Arboleda-Florez (1998) found an association between mental illness and violence, as many factors are known to be out of the patient's control (Stokman, 1984) so causality cannot be truly established. In a meta-analysis of clinical judgements and statistically derived ratings for 'dangerousness' across 23 studies, Buchanan and Leese (2001) analysed the sensitivity/ specificity of these studies in relation to the base rates of violence in people with 'DSPD', finding that six of those so diagnosed would need to be detained just to prevent one violent act.…”