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Focusing on violence from assessment, through underlying neurobiology, to treatment and other recommendations for practice, this book will be of interest to forensic psychiatrists, general adult psychiatrists, psychiatric residents, psychologists, psychiatric social workers and rehabilitation therapists.
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A catalog record for this publication is available from the British Library
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Chapter 30 Crime, violence, and behavioral health: collaborative community strategies for risk mitigation Debra A. Pinals
Violence in society is a public health problem that requires a broad-based approach to understand and diminish. Criminal recidivism is a separate construct, as not all crime is violent, and not all violence ends up criminalized. In the arena of mental health care, there are a number of hurdles that must be overcome with regard to notions of preventing violence and preventing the increased concentration of individuals with mental health and substance use disorders into the justice system. Media portrayals continually link violence with mental illness, which can make separating myth from reality difficult [1]. In a survey conducted during the aftermath of a tragic mass shooting in Newtown, Connecticut, nearly half of respondents reported beliefs that persons with mental illness are more dangerous than others [2].
There have been generations of research on the prevalence of violence and what proportion can be attributed to mental illness, with studies generally demonstrating that mental illness alone accounts for, at most, 3%–5% of violence in our society [3]. In one of the most methodologically sound studies of mental illness and violence, incidents of violence among persons with mental illness were not significantly different from a community sample when there was no substance use [4]. However, the presence of substance use increased the risk that an individual engaged in violence, and a greater proportion of individuals with mental illness also had substance use challenges [4]. Even with those findings, it is critical to recall that individuals with mental illness are more likely to be victims of crime [5]. Furthermore, substance use, trauma histories, and a variety of factors other than mental illness are more likely variables that heighten the risk of violence than mental illness alone [6].
If one looks at the prevalence of criminality among persons with mental illness, one sees a further complicated picture. Studies have shown the high prevalence of criminal justice histories among public mental health populations. Fisher et al. [7], for example, examined a cohort of recipients of public mental health services over 10 years and found that about 28% had experienced at least one arrest, and that within that group, young adults aged 18 to 25 years of age had a 50% chance of one arrest during that period. In other analyses of that general data, odds of arrest for assault and battery on police officers were highest, with misdemeanor crimes against persons and property and crimes against public decency the next highest [8]. Felony behaviors (outside of the assault and battery on a police officer charges) were less common [8]. Swanson et al. [9] reviewed administrative records of individuals within a state mental health system with diagnoses of schizophrenia or bipolar disorder, and found that 1 in 4 individuals was involved with the justice system during a 2-year period.
The prevalence of mental illness and substance use disorders among criminal justice populations is also seen as higher than the general population [10]. This is a critical factor to consider, given the large numbers of people under correctional supervision in the United States. Data from the Bureau of Justice Statistics indicated that almost 7 million offenders were under some type of adult correctional system supervision at year end in 2012, including those incarcerated and out in the community under correctional supervision (with 1 in 50 adults supervised in the community on probation or parole compared to about 1 in every 108 adults who were incarcerated in prison or jail) [11].
Although these prevalence studies might point to mental illness as the key driving feature of justice involvement, other studies provide a more nuanced breakout of associated factors. Factors that heighten the risk of criminal recidivism among persons with mental illness seem to be similar to those that heighten the risk of recidivism among the general population, with one study showing that juvenile justice involvement and multiple prior incarcerations place people at greater risk of arrest than clinical factors [12]. In an analysis of criminal arrest patterns among persons with schizophrenia and psychotic disorders receiving public mental health services, comorbid antisocial personality disorder and substance use disorders seemed to significantly increase the risk for arrest, while among co-existing anxiety disorders, a diagnosis of posttraumatic stress disorder was more likely associated with a risk of arrest for violent crimes [13]. Other studies point to poverty, social disruptions, and inactivity associated with serious mental illness as factors that may produce higher rates of criminogenic need [14,15]. Furthermore, in a recent study examining offenders with mental illness and symptoms that directly preceded criminal behavior, symptoms of mental illness were infrequently the driving feature related to the criminal conduct (only 4%, 3%, and 10% of crimes related directly to symptoms of mental illness such as psychosis, depression, and bipolar disorder, respectively) compared to features such as antisocial traits [16].
The findings of these data point to an area for public health priority – mitigation and harm reduction that involves a variety of interventions in order to decrease criminal recidivism and decrease the incidence of violence. A focus on mental health symptom reduction alone will likely be insufficient to accomplish this. The field of research is pointing to more comprehensive strategies that involve multidimensional treatment planning and criminal justice supervision practices. Over the last several decades, in fact, collaborations between the criminal justice system and the systems providing for mental health and substance use services (i.e., behavioral health systems) have sprung up to address these issues among overlapping populations.
Mario Amore
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
Allen Azizian
Coalinga State Hospital, Coalinga, and Department of Criminology, California State University, Fresno, California, USA
Shannon M. Bader
California Department of State Hospitals, and Patton State Hospital, California, USA
Michael W. Barsom
Department of State Hospitals (DSH) – Metropolitan, Norwalk, California, USA
Nicole R. Bartholomew
Psychology Services, Federal Bureau of Prisons, Big Spring, Texas, USA
Amlan Basu
Broadmoor High Secure Hospital, West London Mental Health NHS Trust, and Institute of Psychiatry, King’s College, London, UK
Charles Broderick
California Department of State Hospitals, Sacramento, California, USA
Rosalie S. Brooman-White
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
Darcy Brown
The School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
Leslie Citrome
Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
Emil F. Coccaro
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
Michael A. Cummings
Department of State Hospitals–Patton, Department of Psychiatry, Patton, California, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, California, USA
Stephen E. Cummings
Department of Psychiatry, San Mateo Medical Center, San Mateo, California, USA
Pál Czobor
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Laura J. Dardashti
California Department of State Hospitals, and Metropolitan State Hospital, California, USA
Mrigendra Das
Broadmoor Hospital, West London Mental Health Trust, Berkshire, amd School of Psychiatry, Oxford Deanery, Oxford, UK
Darci Delgado
California Department of State Hospitals, and Vacaville Psychiatric Program, California, USA
Sean E. Evans
Psychology Department, Department of State Hospitals, Patton, California, and Psychology Department, La Sierra University, Riverside, California, USA
Thomas Fahy
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Jennifer R. Fanning
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
Alan R. Felthous
Division of Forensic Psychiatry, Department of Neurology & Psychiatry, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
E. Fuller Torrey
Department of Psychiatry, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA; Stanley Medical Research Institute, Chevy Chase, Maryland, USA
David Goldman
Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
Jordan H. Grafman
Rehabilitation Institute of Chicago, Chicago, Illinois, USA
Nitin Gupta
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
Margaret Guyer
Central Office Research Review Committee, Massachusetts Department of Mental Health, Massachusetts Mental Health Center Division of Public Psychiatry, and Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Colin A. Hodgkinson
Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
Brian J. Holoyda
Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
Matthew J. Hoptman
Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, Department of Psychiatry, New York, USA, and University School of Medicine, and Department of Psychology, City University of New York, New York, USA
Deborah Horowitz
Office of Training and Development, Massachusetts Department of Mental Health, Westborough, Massachusetts, USA
James E. Hotham
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
Sharon A. Humphreys
Broadmoor High Secure Hospital, West London Mental Health NHS Trust, London, UK
James L. Knoll IV
Division of Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
Rebecca Kornbluh
California Department of State Hospitals, Sacramento, California, USA
Frank Krueger
Molecular Neuroscience Department, George Mason University, Fairfax, and Department of Psychology, George Mason University, Fairfax, Virginia, USA
Fintan Larkin
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
Royce Lee
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
K. Luan Phan
Department of Psychiatry, University of Illinois College of Medicine, Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, and Departments of Psychology, and Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois, USA
Barbara E. McDermott
Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
Jonathan M. Meyer
Department of Psychiatry, University of California–San Diego, San Diego, California Department of State Hospitals, and Patton State Hospital, California, USA
John Monahan
School of Law, University of Virginia, Charlottesville, Virginia, USA
Robert D. Morgan
Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
Debbi A. Morrissette
Neuroscience Education Institute, Carlsbad, California, Department of Biology, California State University, San Marcos, California, and Department of Biology, Palomar College, San Marcos, California, USA
Jennifer A. O’Day
California Department of State Hospitals, and Metropolitan State Hospital, California, USA
Mark E. Olver
Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Matteo Pardini
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, and Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
Debra A. Pinals
Law and Psychiatry Program, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
George J. Proctor
California Department of State Hospitals, and Patton State Hospital, California, USA
Cameron D. Quanbeck
Department of Psychiatry, San Mateo Health System, San Mateo, California, USA
Vanessa Raymont
Department of Medicine, Imperial College London, London, UK
Phillip J. Resnick
Division of Forensic Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Jose L. Romero-Ureclay
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
Benjamin Rose
California Department of State Hospitals, and Napa State Hospital, California, USA
Daniel R. Rosell
Department of Psychiatry, Icahn Medical School, Mount Sinai, New York, and Special Evaluation Program of Mood and Personality Disorders, Icahn Medical School, Mount Sinai, New York, USA
Callum C. Ross
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
Kathy Sanders
Clinical and Professional Services, Massachusetts Department of Mental Health, and Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
Robert J. Schaufenbil
California Department of State Hospitals, Sacramento, California, USA
Marie Schur
California Department of State Hospitals, and Atascadero State Hospital, California, USA
Eric H. Schwartz
California Department of State Hospitals, and Vacaville Psychiatric Program, California, USA
Charles L. Scott
Division of Psychiatry and the Law, Department of Psychiatry and Behavioral Sciences, University of California–Davis School of Medicine, 5 Sacramento, California, USA
Samrat Sengupta
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
Larry J. Siever
Department of Psychiatry, and Special Evaluation Program of Mood and Personality Disorders, Icahn Medical School, Mount Sinai, New York, and Department of Psychiatry and the VISN3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA
Patrick J. D. Simpson
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
Jennifer L. Skeem
School of Social Welfare & Goldman School of Public Policy, University of California–Berkeley, Berkeley, California, USA
Stephen M. Stahl
California Department of State Hospitals, Sacramento, University of California San Diego, California, USA, and University of Cambridge, Cambridge, UK
Maren Strenziok
Department of Psychology, George Mason University, Fairfax, Virginia, USA
Katalin A. Szabo
Department of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
John Tully
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Richard A. Van Dorn
Research Triangle Institute International, Research Triangle Park, Durham, North Carolina, USA
Susan Velasquez
California Department of State Hospitals, and Patton State Hospital, California, USA
Morris Vinestock
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK
Jan Volavka
Department of Psychiatry, New York University School of Medicine, New York, USA
Raziya S. Wang
Behavioral Health and Recovery Services, San Mateo, California, USA
Katherine D. Warburton
California Department of State Hospitals, Sacramento, and Division of Psychiatry and the Law, University of California, Davis, California, USA
Eric M. Wassermann
Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
Christopher L. White
Department of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, California, USA
Stephen C. P. Wong
Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, School of Medicine, University of Nottingham, Nottingham, UK, and Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia