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Treatment engagement and violence risk in mental disorders

  • Eric B. Elbogen (a1), Richard A. Van Dorn (a1), Jeffrey W. Swanson (a1), Marvin S. Swartz (a1) and John Monahan (a2)...
Abstract
Background

Research has uncovered many characteristics related to violence committed by people with mental illness. However, relatively few studies have focused on understanding the connection between violence and dynamic, malleable variables such as a patient's level of treatment engagement.

Aims

To explore the link between community violence and patients' beliefs about psychiatric treatment benefit.

Method

A sample of 1011 adults receiving out-patient treatment for a psychiatric disorder in the public mental health systems of five US states were interviewed.

Results

Bivariate analyses revealed community violence was inversely related to treatment adherence, perceived treatment need and perceived treatment effectiveness. Multivariate analyses showed these three variables were associated with reduced odds of violent and other aggressive acts.

Conclusions

The results suggest clinical consideration of patients' perceptions of treatment benefit can help enhance violence risk assessment in psychiatric practice settings.

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Copyright
Corresponding author
Dr Eric Elbogen, Duke University Medical Center, DUMC 3071, Durham, NC 27710, USA. Tel: +1 919 682 8394; email: eric.elbogen@duke.edu
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
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Treatment engagement and violence risk in mental disorders

  • Eric B. Elbogen (a1), Richard A. Van Dorn (a1), Jeffrey W. Swanson (a1), Marvin S. Swartz (a1) and John Monahan (a2)...
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eLetters

Treatment engagement and violence risk in mental disorders

Arpan Dutta, ST1 (pilot) SHO Psychiatry
03 November 2006

Dear Sir,

Dr. Elbogen and colleagues (2006) presented a questionnaire study looking at community violence and patients beliefs about psychiatric treatment. The study contains some issues that probably do not allow it tobe generalisable to the British population. It looks at sample of 1011 patients from publicly funded institutions. It excludes the elderly and speakers of languages other that English or Spanish And looks at all psychiatric diagnoses. 48% of all homicides in England & Wales are committed by people with mental illness, 16% are committed by ethnic minorities. The study noted the black and ethnic minority population represented 26% of the episodes of serious violence reported, and this didnot include homicide. It would have also excluded any of the prison population. Between 41.5% and 49.5% had a diagnosis of schizophrenia or psychotic disorder, and this represented 29% of the group that committed serious violent offences. This compares with 7% of people who committed homicide in England and Wales. More importantly the National Confidential Enquiry into Suicide and Homocide by people with mental illness found thatonly 11% had contact with mental health services in the last twelve months. Therefore looking at the population who had been selected had at least one contact with mental health services in the last six months is subject to selection bias and would not be a population that would most warrant effort to help. Substance misuse represented 50% of the patients committing serious violence, but only 5 and 6 % of those committing homicide in England and Wales were related to alcohol and drug dependence respectively.

These issues raise the question that although this is well planned and thought out study, do the results apply firstly to the British population, and secondly do they apply to the prevention of the most serious of violent crimes – homicide? A comparative study in England and Wales would need to look at individual psychiatric diagnoses so as to better help clinical practice here.

ReferencesElbogen EB, Van Dorn RA, Swanson JW, Swartz MS ,et al. (2006) Treatment engagement and violence risk in mental disorders British Journal of Psychiatry, 189, 354-360

Department of Health (2001) Safety First: five year report of the national cofidential enquiry into suicide and homocide by people with mental illness London: Department of Health

Declaration of interestNone

Dr. Arpan DuttaST1 (pilot) SHO Psychiatry5 Boroughs Partnership, Sherdley Unit, Whiston Hospital, Merseyside, L35 5DR
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Conflict of interest: None Declared

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