Objective: This review examined U.S. empirical studies published since 1990 of the perpetration of violence and of violent victimization among persons with severe mental illness and their relative importance as public health concerns. Methods: MEDLINE, PsycINFO, and Web of Science were searched for published empirical investigations of recent prevalence or incidence of perpetration or victimization among persons with severe mental illness. Studies of special populations were included if separate rates were reported for persons with and without severe mental illness. Results: The search yielded 31 studies of violence perpetration and ten studies of violent victimization. Few examined perpetration and victimization in the same sample. Prevalence rates varied by sample type and time frame (recall period). Half of the studies of perpetration examined inpatients; of these, about half sampled only committed inpatients, whose rates of perpetration (17%–50%) were higher than those of other samples. Among outpatients, 2% to 13% had perpetrated violence in the past six months to three years, compared with 20% to 34% who had been violently victimized. Studies combining outpatients and inpatients reported that 12% to 22% had perpetrated violence in the past six to 18 months, compared with 35% who had been a victim in the past year. Conclusions: Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population. Victimization is a greater public health concern than perpetration. Ironically, the discipline’s focus on perpetration among inpatients may contribute to negative stereotypes. (Psychiatric Services 59:153–164, 2008)

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Perpetration of Violence, Violent Victimization, and Severe Mental Illness : Balancing Public Health Concerns

BACKGROUND
Actuarial risk assessment instruments (ARAIs) estimate the probability that individuals will engage in future violence.


AIMS
To evaluate the ;margins of error' at the group and individual level for risk estimates made using ARAIs.


METHOD
An established statistical method was used to construct 95% CI for group and individual risk estimates made using two popular ARAIs.


RESULTS
The 95% CI were large for risk estimates at the group level; at the individual level, they were so high as to render risk estimates virtually meaningless.


CONCLUSIONS
The ARAIs cannot be used to estimate an individual's risk for future violence with any reasonable degree of certainty and should be used with great caution or not at all. In theory, reasonably precise group estimates could be made using ARAIs if developers used very large construction samples and if the tests included few score categories with extreme risk estimates.

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Evaluating the 'margins of error' of group v. individual predictions of violence

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more ...

International Perspectives on the practical application of violence risk assessment : a global survey of 44 countries

Objectives: To undertake a systematic review on structured violence risk assessment tools in individuals with schizophrenia. Methods: A systematic search was conducted from 1990 to 2011 to identify violence risk assessment tools and studies examining their predictive validity. Item content of the identified instruments was analyzed, and areas under the curve (AUC) from the studies were extracted. In addition, an 11-item checklist was developed to assess the utility and psychometric properties of these tools. Results: Ten risk assessment tools designed to predict community violence in psychiatric patients were identified, but only 2 studies reporting predictive validity estimates in patients with schizophrenia were found (median AUC 50.69; interquartile range 5 0.60–0.77). When inclusion criteria was broadened to include studies measuring accuracy for any diagnostic group, mixed evidence of predictive validity was found, with median AUCsrangingfrom0.62to0.85dependingonthepopulation. Item content included mostly clinical, sociodemographic, and criminalhistoryfactors.Asonly1toolincludedaneurobiologicalitem,astructuredreviewofbrain-basedandcognitiverisk factors for violence was included, and 3 clusters (neurocognitive ability, neurocognitive awareness, and attitudinal cognition) were identified. Conclusions: While a number of violenceriskassessmenttoolsexistthatcanbeusedtopredict the likelihood of community violence in psychiatric patients, there is currently little direct evidence for their utility in individualswithschizophrenia.Inaddition,thereislargevariation in item content between instruments, and further research is necessarytodeterminewhethertheinclusionofalternativefactors could improve risk assessment.

/pdf/structured-assessment-of-violence-risk-in-schizophrenia-and-4xa7lzxbrc.pdf

Structured Assessment of Violence Risk in Schizophrenia and Other Psychiatric Disorders: A Systematic Review of the Validity, Reliability, and Item Content of 10 Available Instruments

This paper discusses the concerns associated with the introduction of, and increased reliance on, actuarial risk tools in sentencing in order to: (1) stimulate cross-disciplinary dialog and researc...

Actuarial Sentencing: An “Unsettled” Proposition

The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.

The Classification of Violence Risk

The Classification of Violence Risk (COVR®) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software l...

Steven M. Banks

Papers

The Classification of Violence Risk

The Classification of Violence Risk.