Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil

Abstract

Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

Institucionalização prolongada, transtornos mentais e violência: uma revisão científica sobre o tema

“…In the studies included in this review, the "history of violence" factor appears as a significantly isolated item, and this information is corroborated by several other authors (Mecler, 2010;Oliveira et al, 2017;Teixeira et al, 2007). However, such information in no way helps to prevent the first violent episodes and does not provide any information about which factors might actually give rise to the risk of violent behavior, so that it can be modified and dealt with.…”

“…Regarding the prediction of violent behavior, Oliveira et al (2017) concluded that the use of validated instruments and the development of a semi-structured interview with the purpose of assessing the risk of violence in psychiatric patients in custody would be ways of circumventing or, at least, reducing possible distortions. Also according to the authors, research that provides data to help the identification of individuals suffering from mental disorders who are at risk of violent behavior, as well as their proper treatment, can contribute to the prevention of this conduct, as well as its expression within the social environment.…”

“…Several studies have sought to associate the risk of violence with mental health disorders, but many have described small or specific samples, such as populations exclusively selected from custody hospitals or even prisons, resulting in an inadequate analysis of the mental health disorders themselves (Adshead, 1998;Flannery Junior et al, 2000;Kramp;Gabrielsen, 2009;Moscatello, 2001;Oliveira et al, 2017;Short et al, 2013). On the other hand, there are other studies demonstrating relations contrary to this (Fazel;Yu, 2011;Ghoreishi et al, 2015;Mecler, 2010;Oliveira et al, 2016).…”

Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review

“…There are three types of hospitalization: voluntary admission where the patient consents to treatment, involuntary admission where there is only partial consent, and forced admission in the event that the patient denies consent. Forced hospitalization occurs when necessary, while involuntary admission must be authorized by a judge (58).…”

Antisocial personality disorder, psychopathy and media

“…The legal concept of mental insanity refers to the ability of the individual to know whether his actions are right or wrong and that he has been able to choose them in a conscious and voluntary way. In forensic psychiatry evaluation, these individuals are most commonly considered criminally responsible, and eventually partiallyresponsible (when there is loss of determination in the perpetration of the offence) 6 .…”