4 research outputs found
Violence among mentally disordered offenders : Risk and protective factors
Background: Violence is one of the leading causes of unnatural deaths,
and the consequences of violence for victims, victims families,
offenders, and society at large involve extensive suffering and monetary
costs. Improving strategies to prevent and reduce violence is of great
importance, and refining techniques for risk assessments in forensic and
correctional settings is assumed to be one way of doing so. The
procedures currently used for risk assessment mainly focus unchangeable,
static risk factors, and provide few directions as to what clinicians can
do in order to decrease a client s risk by treatment and management. The
aim of this thesis was to improve understanding of the violence relapse
process, to identify triggers and protective factors for violence among
mentally disordered offenders, and to develop a structured model for the
management of violence risk in forensic mental health after-care.
Methods: This thesis used both qualitative and quantitative research
designs. To identify protective factors of violent behaviour we
interviewed individuals, selected from a cohort of 401 violent offenders
who had unexpectedly ended their criminal career (n=4; Paper I).
Semistructured interviews were likewise conducted to explore the violence
relapse process and communication of risk among offenders who had
relapsed into criminal violence (n=14; Paper II). Content analysis was
used for the exploration of data. In the quantitative studies, which
aimed to identify triggers of violence among offenders, we used the
case-crossover design, by which each subject serves as his or her own
control. Structured interviews were performed with 133 violent offenders
with respect to hypothesised triggers (Papers III and IV). Standard
Mantel-Haenszel methods were used for the statistical analyses. To
develop a structured model for the management of mentally disordered
offenders, we gathered law, criminology, and mental health professionals
with different educational backgrounds to elicit clinically relevant
contextual and individual factors related to the individual outcome
following forensic psychiatric hospitalisation (Paper V).
Results: Qualitative studies suggested that the desistance process among
individuals with long criminal and violent careers was triggered by a
shocking experience related to their criminal lifestyle and insight about
the negative consequences to that lifestyle. Suggested protective factors
were a strong relationship with family, social and geographical
isolation, and the identification and avoidance of potential risk
situations. Important risk factors in the relapse process were
separations, drug problems, homelessness, and acute risk factors were
lack of sleep, substance intoxication and conflicts. Some of these acute
risk factors of violence were tested and confirmed in the quantitative
case-crossover study. Acute suicidal ideation/ parasuicide and alcohol
intoxication were among the most important triggering factors. Acute
conflicts and being denied psychiatric care also increased the risk of
criminal violence. In contrast, potential inhibitors of violence were
regular doses of benzodiazepines and antidepressants. All but one of the
mentally disordered offenders interviewed in the relapse study had, by
their own account, communicated that there was a risk of acting
violently. The communication patterns were directed towards professionals
and acquaintances and were verbal and non-verbal. Finally, a structured
model for management of violence risk in forensic psychiatric after-care
called the SORM (Structured Outcome Assessment and Community Risk
Monitoring) was developed.
Conclusions: This thesis points to several potentially fruitful research
areas for the violence prevention field. Previously, communication of
risk has only been addressed in clinical work with suicidal patients,
even though this may be of substantial interest also in the field of
violence prevention. Some triggering and protective factors of violence
among mentally disordered offenders were identified in this thesis, but
needs to be replicated in future studies. The case-crossover design, for
the first time applied to study triggers of aggressive acts, may
substantially advance research on acute risk factors of violence