Capturing Change: An Approach to Managing Violence and Improving Mental Health

Recently colleagues of ours discoursed on the topic of treatment effectiveness as it relates to persons with serious mental and personality disorder (Harris & Rice, 1997). They introduced their piece by pointing out that, although they had never encountered a fully effective intervention programme, they would in all likelihood recognize one such if they were to see it. Our present outlook is similar to that of Harris and Rice but goes a step further. We suggest that even if a programme is actually effective, chances are that behavioural and attitudinal changes will be indexed so haphazardly, if at all, that they will not be captured and so will not enter the record. And if positive changes are not pinned down during treatment or intervention the result can be to the great detriment of the individual patient, prisoner, or parolee. By the same token, if absence of changes or negative changes are not taken into account, innocent members of society can be placed at risk for violence. It will be argued here that, despite the almost mesmerizing abundance of validated, semi-validated, and unvalidated tests and scales for risk assessment on the market, there exist in fact few clinically relevant, procedurally fair devices for measuring changes in riskrelevant "dynamic" factors on an interdisciplinary basis. This would apply to measurements both in institutions and in the community. We would also like to posit that serious attempts to document dynamic changes could very possibly have salutary effects, meaning that the mere focus on indexing changes may play an important if minor role in inducing them. The notion of "dynamic" change requires some comment. Later in the chapter, especially as we discuss the Historical, Clinical Risk (HCR-20) Scheme (Webster, Douglas, Eaves, & Hart, 1997), we draw a distinction between static, more-or-Iess demographic, largely unchangeable, file-based factors and dynamic, alterable, mainly clinical variables. In this chapter emphasis is placed much more on the latter than on the former. We are interested in exploration of variables known to have the potential to elevate or reduce risk of violence in institutions and in the community. If these variables can be agreed upon, defined, and measured, there is at least some

[1]  J. Monahan.  Predicting Violent Behavior: An Assessment of Clinical Techniques , 1981 .

[2]  S. Rosenfield.  Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. , 1984, Journal of health and social behavior.

[3]  Daryl J. Bem,et al.  ON PREDICTING SOME OF THE PEOPLE SOME OF THE TIME: THE SEARCH FOR CROSS-SITUATIONAL CONSISTENCIES IN BEHAVIOR , 1974 .

[4]  Judith E. Mack,et al.  The child care worker in the family: Some case examples and implications for the design of family-centered programs , 1979 .

[5]  V. Quinsey,et al.  Proximal Antecedents of Eloping and Reoffending Among Supervised Mentally Disordered Offenders , 1997 .

[6]  D. Lewis,et al.  Psychiatric Diagnoses and Racial Bias: An Empirical Investigation , 1989 .

[7]  K. Heilbrun.  Violent offenders: Appraising and managing risk. , 1998 .

[8]  P. Yarnold.  Classical Test Theory Methods for Repeated-Measures N = 1 Research Designs , 1988 .

[9]  S. Pfohl.  Predicting dangerousness: The social construction of psychiatric reality , 1978 .

[10]  J. Monahan,et al.  A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools , 2000, Law and human behavior.

[11]  Kirk Heilbrun,et al.  Prediction Versus Management Models Relevant to Risk Assessment: The Importance of Legal Decision-Making Context , 1997, Law and human behavior.

[12]  Peter Medawar,et al.  The art of the soluble , 2021, Nature.

[13]  S. Shah,et al.  Dangerousness: a paradigm for exploring some issues in law and psychology. , 1978, The American psychologist.

[14]  Edwin I. Megargee,et al.  The Prediction of Dangerous Behavior , 1976 .

[15]  C. Webster,et al.  Construction and validation of risk assessments in a six-year follow-up of forensic patients: a tridimensional analysis. , 1995, Journal of consulting and clinical psychology.

[16]  R. G. Hunt,et al.  Social Class and Mental Illness , 1959 .

[17]  C. Webster,et al.  The dimensions of dangerousness , 1985 .

[18]  R. Eisenman.  Sexual acting out: Diagnostic category or moral judgment? , 1987 .

[19]  C. Webster,et al.  The HCR-20 Violence Risk Assessment Scheme , 1999 .

[20]  T. Mathiesen,et al.  Selective Incapacitation Revisited , 1998 .

[21]  J. Monahan.  Mental disorder and violent behavior. Perceptions and evidence. , 1992, The American psychologist.

[22]  Statistical Analysis for Single-Case Designs , 1991, Behavior modification.

[23]  Christopher D. Webster,et al.  Predicting Violence in Mentally and Personality Disordered Individuals , 1999 .

[24]  R. Merton.  The unanticipated consequences of purposive social action , 1936 .

[25]  M Petrunik,et al.  The politics of dangerousness. , 1982, International journal of law and psychiatry.

[26]  W. Mischel.  Personality and Assessment , 1996 .

[27]  C. Webster.  Comment on Thomas Mathiesen's Selective Incapacitation Revisited , 1998 .

[28]  C. Gagne,et al.  Psychological and Social Aspects of Psychiatric Disability , 1997 .

[29]  W. Lutz,et al.  Exploring individual change. , 1998, Journal of consulting and clinical psychology.

[30]  Dangerous Offenders: The Elusive Target of Justice , 1985 .

[31]  Bruce G. Link,et al.  The violent and illegal behavior of mental patients reconsidered. , 1992 .

[32]  John Monahan,et al.  Violence and mental disorder: Developments in risk assessment. , 1994 .

[33]  D. Smith.  Living with Children , 1944 .

[34]  D. Vandell,et al.  Perceptions of danger: a psychological mediator of neighborhood demographic characteristics. , 1998, The American journal of orthopsychiatry.

[35]  J. Whitehead.  Violence in Institutions , 1975 .

[36]  A. Kazdin.  A model for developing effective treatments: progression and interplay of theory, research, and practice. , 1997, Journal of clinical child psychology.

[37]  M. Rutter,et al.  Antisocial behavior by young people. , 1998 .

[38]  C. Webster,et al.  Physical Attractiveness, Dangerousness, and the Canadian Criminal Code1 , 1988 .

[39]  V. Quinsey,et al.  Variables affecting psychiatrists' and teachers' assessments of the dangerousness of mentally ill offenders. , 1979, Journal of consulting and clinical psychology.

[40]  D. Farrington,et al.  Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions , 1999 .

[41]  R. Hare.  The Hare PCL‐R: Some issues concerning its use and misuse , 1998 .

[42]  Göran Fransson,et al.  Clinical and risk management factors in risk prediction of mentally disordered offenders‐more important than historical data?: A retrospective study of 40 mentally disordered offenders assessed with the HCR‐20 violence risk assessment scheme , 1999 .

[43]  Kim T. Mueser,et al.  Social Skills Training for Schizophrenia: A Step-by-Step Guide , 1997 .

[44]  Christopher D. Webster,et al.  Violence risk assessment: Science and practice , 1999 .

[45]  Fredrick C. Redlich,et al.  Social class and mental illness: Community study. , 1958 .

[46]  M. E. Rice.  Violence in Institutions: Understanding, Prevention and Control , 1989 .

[47]  R Borum,et al.  Improving the clinical practice of violence risk assessment. Technology, guidelines, and training. , 1996, The American psychologist.

[48]  E. Foa,et al.  PTSD and major depression: Methodological and treatment considerations in a single case design* , 1995 .

[49]  D. Stoff,et al.  Handbook of antisocial behavior , 1997 .

[50]  E. Mulvey,et al.  Conditional prediction: a model for research on dangerousness to others in a new era. , 1995, International journal of law and psychiatry.

[51]  Henrik Belfrage,et al.  Implementing the HCR-20 scheme for risk assessment in a forensic psychiatric hospital: Integrating research and clinical practice , 1998 .

[52]  K S Douglas,et al.  Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version. , 1999, Journal of consulting and clinical psychology.