Chronic Violent Patients in an Inpatient Psychiatric Hospital

Abstract

This study examines the prevalence and the individual characteristics of chronically violent patients (CVPs) in a psychiatric hospital during inpatient treatment. The study is based on a 1-year follow-up investigation of all violent episodes committed by a sample of 527 patients in a forensic psychiatric hospital in British Columbia, Canada. Sociodemographic, legal and criminological, historical, and clinical factors were analyzed using a risk assessment scheme. Approximately 10% of the sample was responsible for more than 60% for all violent episodes recorded during the study period. Those CVPs were characterized by historical, but mostly clinical, risk factors. Moderate to good predictive accuracy was achieved when defining CVPs as individuals who perpetrated 15 or more violent episodes. Important limitations of the actuarial approach were also highlighted by the presence of two qualitatively different groups of CVPs. The results are discussed in light of the scientific literature on the risk management of inpatient violence.

Predicting violence among individuals who engage in self-injury

“…Finally, individuals with a history of NSSI tend to report engaging in more impulsive behaviour (Herpertz, Sass, & Favazza, 1997) and demonstrate more impulsive behaviour in laboratory tasks than individuals who do not engage in NSSI (Glenn & Klonsky, 2010 (White et al, 1999). In addition, a diagnosis of substance use disorder has been associated with chronic engagement in violence (i.e., 15 or more episodes of violence) in a psychiatric inpatient sample (Lussier et al, 2010). Similar to impulsivity, substance misuse is considered to be an important risk factor for violent behaviour (Monahan et al, 2000;Douglas & Kropp, 2002), and is included as a standalone item in a frequently used violence risk assessment guide (i.e., HCR-20; Webster et al, 1997).…”

“…Previous research in the area of violence risk assessment has consistently noted the strong association of personality disorders with violence (Rabkin, 1979;Lussier, Verdun-Jones, Deslauriers-Varin, Nicholls, & Brink, 2010). Moreover, the presence of a personality disorder is often considered to be a risk factor for future violent behaviour (Webster et al, 1997;Douglas & Kropp, 2002).…”

“…Moreover, the presence of a personality disorder is often considered to be a risk factor for future violent behaviour (Webster et al, 1997;Douglas & Kropp, 2002). In particular, antisocial personality disorder (ASPD) has a robust relationship with violent behaviour (Meloy, 1995;Bonta, Law, & Hanson 1998;Lussier et al, 2010), and violent or aggressive behaviours toward others comprise one of the criteria for a diagnosis of of longitudinal studies by Bonta and colleagues (1998) found that a diagnosis of ASPD was the strongest personality predictor of general and violent recidivism. In addition, antisocial or negative attitudes are also considered to be risk factors for violence (Webster et al, 1997); thus, even without a diagnosis of ASPD, the presence of antisocial or negative attitudes may place an individual at a higher risk for engaging in violence toward others.…”

Coercion in Forensic Healthcare: A North American Perspective

“…Further examination of the sample revealed that a small subset (10 %) of the population (N ¼ 527) was responsible for 60 % of all perpetrated aggression (Lussier et al 2010). An analysis of patients who were responsible for 15 or more violent episodes, and thus had more SR incidents, revealed that they were more likely to be female, have a prior criminal record for violent crime and have been found unfit or NCR on previous occasions.…”

An acceptance and commitment therapy based protocol for the management of acute self-harm and violence in severe mental illness

“…Additional evidence also points to a particular subset of individuals perpetrating this violence. It tends to be young males with a history of violence (El-Badri & Mellsop, 2006) and it also tends to be the same people (Lussier et al 2009). …”