Showing papers by "John Monahan published in 1999"

The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.

Abstract: OBJECTIVES: The authors examined Americans' opinions about financial and treatment competence of people with mental health problems, potential for harm to self or others, and the use of legal means to force treatment. METHODS: The 1996 General Social Survey provided interview data with a nationally representative sample (n = 1444). Respondents were given a vignette based on diagnostic criteria for schizophrenia, major depression, alcohol dependence, or drug dependence, or a "control" case. RESULTS: The specific nature of the problem was the most important factor shaping public reaction. Respondents viewed those with "troubles," alcohol dependence, or depression as able to make treatment decisions. Most reported that persons with alcohol or drug problems or schizophrenia cannot manage money and are likely to be violent toward others. Respondents indicated a willingness to coerce individuals into treatment. Respondent and other case characteristics rarely affected opinions. CONCLUSIONS: Americans report gre...

Assessing violence risk among discharged psychiatric patients: toward an ecological approach.

Abstract: This paper draws upon data from the Pittsburgh site of the MacArthur Foundation's Risk Assessment Study, a large-scale study of violence risk among persons discharged from psychiatric hospitals, to examine the effect of the neighborhood context on risk of violence. This paper has two purposes: (1) to assess the extent to which the inclusion of neighborhood characteristics enhances violence prediction models—models that traditionally only include individual-level characteristics; and (2) to assess the consistency of individual level risk factors across different neighborhood contexts. Results indicate that neighborhood poverty has an impact over and above the effects of individual characteristics in identifying cases with violence. These findings support efforts to include neighborhood context in the assessment and management of violence risk among discharged psychiatric patients.

Real in their consequences: A sociological approach to understanding the association between psychotic symptoms and violence.

Abstract: Studies conducted over the past three decades have consistently reported an association between mental illness and violence. We propose a sociologically inspired explanation for this association by referring to the Thomas Theorem - if situations are defined as real, they are real in their consequences. We identify a small subset of psychotic symptoms, termed threat/control-override symptoms, that tend to induce violence because they influence the definitions of situations. Our data come from an epidemiological study conducted in Israel that includes a psychiatrist-administered diagnostic interview. We find an association between violent behaviors and psychiatric diagnosis that cannot be accounted for by sociodemographic variables. Threat/control-override symptoms also are strongly related to violent behaviors and explain a substantial part of the association between violence and psychiatric diagnoses. Other equally severe psychotic symptoms are not related to indicators of violence when threat/control-override symptoms are controlled. These findings support our explanation for the association between mental illness and violence, and challenge the stereotype that most people with mental illnesses are dangerous

Patients' revisions of their beliefs about the need for hospitalization.

Abstract: OBJECTIVE: An influential rationale for involuntary hospitalization is that prospective patients who refuse hospitalization at the time it is offered are likely to change their belief about the necessity of hospitalization after receiving hospital treatment. The authors examine how patients changed their evaluations of psychiatric hospitalization following hospital treatment. METHOD: The authors studied 433 patients who were interviewed about their hospitalization within 2 days of their admission to a psychiatric hospital; 267 of these patients were reinterviewed 4–8 weeks following discharge. RESULTS: When reinterviewed at follow-up, 33 (52%) of 64 patients who said at admission that they did not need hospitalization said that, in retrospect, they believed they had needed it. Only 9 (5%) of 198 patients who said at admission that they needed hospitalization shifted to saying that they had not needed it. CONCLUSIONS: Many of the patients who initially judged that they did not need hospitalization revised ...

Coercion in Mental Health Services-International Perspectives

Abstract: List of contributors. Coercion and mental health services: introduction and overview (J.P. Morrissey, J. Monahan). Innovative US Studies. Coercion in the provision of mental health services: the Macarthur studies (J. Monahan et al.). Assessing the operation of a New York City program for involuntary outpatient commitment (H.J. Steadman et al.). Measuring coercion under involuntary outpatient commitment: initial findings from a randomized controlled trial (M.B. Swartz et al.). Conceptual, Measurement, and Outcome Issues - Nordic and American Views. Coercion in psychiatry: an analytical overview (A. Syse). Clients' perception of coercion: a research perspective (G. Hoyer). Methodological issues in measuring coercion in psychiatric treatment (R. Kaltiala-Heino). The effects of coerced psychiatric hospitalization and treatment (R. Nicholson). Ethical considerations: American and British Perspectives. Ethical issues on coercion research in mental health systems (J. Allen). Broadening the agenda of coercion research: addressing the sociopolitical context of risk, violence, and mental disorder (A. Rogers). Bibliographic Resources. Tracing the development of outpatient commitment: an annotated bibliography (D.L. Dennis).