Identifying Psychiatric Patients at Risk for RepeatedInvolvement in Violence: The Next Step Toward Intensive Community Treatment Programs

©2002 International Association of Forensic Mental Health Services Violence tends to be concentrated in a small subgroup of the population (Blumstein, Cohen, Roth, & Visher, 1986). This pattern applies to violence involving individuals with mental disorders as well. For example, Gardner, Mulvey, Lidz, and Shaw (1996) found that 5% of psychiatric patients followed in their community samples were involved in 45% of all reported violent incidents in the sample. More recently, Banks et al. (in press) found that 15% of psychiatric patients enrolled in their study were involved in 67% of identified violent incidents. There is some evidence that these frequently violent patients’ incidents are more serious (e.g., assaults requiring medical treatment) than incidents in which “occasionally violent” patients are involved (Gardner et al., 1996). Relatively little is known about methods for identifying patients involved in frequent and serious violence. Research on violence risk typically focuses on distinguishing patients who are likely to be involved in one or more violent incident from those with no involvement in violence (Borum, 1996). Although this work has advanced risk assessment technology (Douglas, Ogloff, Nicholson, & Grant, 1999; Quinsey, Harris, Rice, & Cormier, 1998; Monahan et al., 2001), most of it is nonetheless limited in its ability to guide intervention efforts with high risk patients in the community (see Skeem & Mulvey, 2002). Differentiating individuals who are likely to commit a violent act (or multiple violent acts) from those who are not likely to commit such acts is only the first step in efficiently and effectively using treatment resources. Although this information allows for categorizing individuals into high or low risk groups, it does not go the next step in identifying those high risk individuals who pose the most predictable, ongoing risk for violence. It is important to find and intervene with patients who are repeatedly violent for two reasons. First, identifying these patients would allow mental health Identifying Psychiatric Patients at Risk for Repeated Involvement in Violence: The Next Step Toward Intensive Community Treatment Programs