Article2006

Violence and Leveraged Community Treatment for Persons With Mental Disorders

Jeffrey W. Swanson · Richard A. Van Dorn · John T Monahan · Marvin S. Swartz

63 citations0/0 files storedAmerican Journal of Psychiatry

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Healthcare Decision-Making and Restraints Psychiatric care and mental health services Psychopathy, Forensic Psychiatry, Sexual Offending

Abstract

OBJECTIVE: This article explores the link between violence and the practice of legally mandating treatment in the community or leveraging benefits from the social welfare system, such as subsidized housing and disability income support, to ensure adherence to treatment. METHOD: Data are presented from a survey of 1,011 persons with psychiatric disorders receiving treatment in public mental health service systems in five U.S. cities. Multinomial logit analysis was used to examine the association between physically assaultive behavior and experience of social welfare leverage, legal leverage, or both types of leverage, with the analyses controlling for demographic and clinical characteristics. RESULTS: Across study sites, 18% to 21% of participants reported having committed violent acts in the past 6 months; 3% to 9% reported having used or made threats with a lethal weapon, committed sexual assault, or caused injury. About three-quarters of subjects who reported such serious violence also reported having experienced some form of leveraged treatment, compared with about one-half of subjects who did not report serious violence. Demographic and clinical factors that were independently associated with the likelihood of experiencing both types of leverage included younger age, male gender, poorer clinical functioning, more years in treatment, more frequent hospitalizations, higher frequency of outpatient visits, and negative attitudes toward medication adherence. Among participants who did not voluntarily take psychotropic medication, even minor assaultiveness was associated with having experienced legal leverage. CONCLUSIONS: A combination of concerns about safety and treatment nonadherence may influence decisions by clinicians and judges to apply legal leverage.

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References

1998Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods 1994Violence and mental disorder: developments in risk assessment 2001Rethinking Risk Assessment 2001Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence 2006A National Study of Violent Behavior in Persons With Schizophrenia 1999The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.1988Anchoring the BPRS: an aid to improved reliability.1999Can Involuntary Outpatient Commitment Reduce Hospital Recidivism?: Findings From a Randomized Trial With Severely Mentally Ill Individuals

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2008Psychosis and Violence: Stories, Fears, and Reality

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