Violence among the Mentally III: Effective Treatments and Management Strategies (Nato Science Series D: Book 90)

The NATO Advanced Study Institute on the Prevention of Crime and Violence Among the Mentally III was held in May 1999 in Tuscany, Italy. Participants from 15 countries attended. Since care for persons with mental illness (schizophrenia, major depression, bipolar disorder, delusional disorder, atypical psychoses) has been deinstitutionalized, some persons with these disorders are committing crimes and serious violence. Consequently, societies around the world are confronted with a new challenge: to provide mental health care and social services to mentally ill persons in a humane way that will prevent illegal behaviours. Research in this field has been dominated by investigations designed to improve clinicians' accuracy in predicting violent behaviours, with little attention focused on the organization and implemen­ tation of treatments. The premise of the Advanced Study Institute was that treatments must have em­ pirically proven efficacy. Both professional ethics and public accountability require empirical evidence that each treatment will alleviate the problem that it targets. However, despite the fact that Western industrial societies provide treatment for mentally ill persons who have offended, there is a very limited base of knowledge on what constitutes effective treatment and how such treatments should be organized and delivered. The Advanced Study Institute was an attempt to stimulate and encour­ age research that will extend this knowledge base. The goals were to review what is known about mentally ill offenders and about effective treatments for them, and to provide a framework for the orientation of future investigations designed to improve treatment efficacy. Front Matter....Pages i-xiv Front Matter....Pages 1-1 Major Mental Disorders and Crime in the Community....Pages 3-18 Reducing Violence Risk....Pages 19-34 Immediate Precursors of Violence Among Persons with Mental Illness....Pages 35-48 Commentary....Pages 49-57 Etiological Factors Linked to Criminal Violence and Adult Mental Illness....Pages 59-75 Commentary....Pages 77-87 The Etiology and Development of Offending Among Persons with Major Mental Disorders....Pages 89-116 Front Matter....Pages 117-117 Capturing Change....Pages 119-144 Treatment Implications of the Antecedents of Criminality and Violence in Schizophrenia and Major Affective Disorders....Pages 145-169 Pharmacological Intervention for Preventing Violence Among the Mentally Ill with Secondary Alcohol-And Drug-Use Disorders....Pages 171-191 Pharmacological Interventions for Preventing Violence Among the Mentally Ill with Co-Occurring Personality Disorders....Pages 193-209 Front Matter....Pages 211-211 Institutional Violence Among the Mentally Ill....Pages 213-235 High-Risk Factors for Violence....Pages 237-250 Violence Against Others by Psychiatric Hospital Inpatients with Psychosis....Pages 251-275 Effective Treatment Strategies for Preventing Violence on Psychiatric Wards....Pages 277-288 Front Matter....Pages 289-289 Major Mental Disorder and Violence in Correctional Settings....Pages 291-311 Effective Treatment for Disturbed Violent Prisoners?....Pages 313-337 Front Matter....Pages 339-339 The Efficacy and Effectiveness of Community Treatment Programmes in Preventing Crime and Violence Among those with Severe Mental Illness in the Community....Pages 341-357 Commentary....Pages 359-366 Social Services Necessary for Community Treatment Programmes Designed to Prevent Crime and Violence Among Persons with Major Mental Disorders....Pages 367-382 Front Matter....Pages 339-339 Social and Community Services and the Risk for Violence Among People with Serious Psychiatric Disorders....Pages 383-387 Community Treatment Programmes in Europe and the United Kingdom that have Proven Effective in Preventing Violence by the Mentally Ill in the Community....Pages 389-408 Treatment of Mentally Ill Offenders in the Community....Pages 409-416

The book, written by some of the leading researchers in the world in the field of mental illness and crime, starts by reviewing investigations of crime and violence by the mentally ill in the community, in hospitals and in correctional facilities. It goes on to review the development of offending and violent behaviour among persons with mental illness. Subsequent chapters document what is known about the effective prevention of offending and violent behaviour among the mentally ill. The provision of treatment in the community, in hospitals and correctional facilities is then critically reviewed and discussed, with specific descriptions of pharmacological and behavioural treatments. Compliance with treatment is discussed at length. Methodological issues in measuring the effectiveness of treatment of mentally ill offenders are described, with recommendations for future studies to evaluate treatments.

Proceedings of the NATO Advanced Study Institute on Effective Prevention of Crime and Violence among Persons with Major Mental Disorders, Il Ciocco, Italy, 16-26 May 1999