Violence Risk Assessment
Presented by Leonard William Mulbry, Jr., M.D.
South Carolina Forensic Psychiatry
Covering the Topics of:
- Evaluation of Correctional Population
- Evaluation of Psychiatric Population
- Evaluation of Inpatient Psychiatric Population
- Evaluation for Employment
Study of Violent Behavior
Personality Research
Personality research traces its origins to 1890's Germany.
- Hervey Cleckley MD (1941)
- Robert Hare PhD (1991)
- Devised PCL (Psychopathy Checklist,) later PCL-R (revised)
- Defining psychopathy as "chronic immoral and antisocial behavior."
- Attempting to identify "Fledgling psychopaths" in juvenile populations.
Social Deviancy Research
Social Deviancy Research traces it origins to 1960's U.S.
- Lee Robbins PhD (1966)
- Defining Antisocial Personality Disorder (APD/ASPD) as "a pervasive pattern of disregard for, and violation of, the rights of others."
- Defining Conduct Disorder as "a repetitive behavior where the rights of others or the current social norms are violated."
- DSM-IV-R (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
Antisocial Personality Disorder
The individual must be age 18 or older.
The individual must have exhibited a Conduct Disorder before age 15.
Antisocial Personality Disorder requires three of the following characteristics:
- A failure to conform to social norms
- Irritability and aggression
- Consistent irresponsibility
- Impulsivity or failure to plan ahead
- Deceitfulness
- Reckless disregard for safety of self or others
- Lack of remorse
Psychopathy
As studied by Cleckly (1941)
Psychopaths exhibit superficial charm and good intelligence.
Psychopaths exhibit an absence of delusions and irrational thought.
Psychopaths exhibit an absence of nervousness.
Psychopaths exhibit unreliability.
Psychopaths exhibit untruthfulness.
Psychopaths exhibit a lack of remorse of shame.
Psychopaths exhibit inadequately motivated antisocial behavior
Psychopaths exhibit poor judgment and failure to learn from experience.
Psychopaths exhibit pathological egocentricity and incapacity for love.
Psychopaths exhibit a general poverty of major affective reaction.
Psychopaths exhibit a specific loss of insight.
Psychopaths exhibit unresponsiveness in interpersonal relations.
Psychopaths exhibit fantastic and uninviting behavior.
Psychopaths rarely commit suicide.
Psychopaths exhibit an impersonal, trivial and poorly integrated sex life.
Psychopaths exhibit a failure to follow any life plan.
Violence Risk Assessment
Impact of Mental Illness (Swanson 1990)
| Diagnosis | % reporting violence |
|---|---|
| No diagnosis | 2 |
| Obsessive-Compulsive Disorder | 11 |
| Panic Disorder | 12 |
| Major Depressive Disorder | 12 |
| Bipolar Affective Disorder | 11 |
| Schizophrenia | 13 |
| Cannabis Abuse & Dependence | 19 |
| Alcohol Abuse & Dependence | 25 |
| Other Substance Abuse & Dependence |
35 |
Violence Risk Assessment
Impact of Mental Illness (Monahan 1997)
There is a weak relationship between mental illness and violence.
Most people with mental illness are not violent.
Victims of mentally ill people are rarely strangers
Substance abuse is a much greater risk factor than is mental illness.
Violent behavior in the mentally ill is only manifested during acute symptoms
Violence Risk Assessment
Approaches
Clinical Approach
The Threat Assessment Model of violence risk assessment is tailored to the patient.
Actuarial Approach
The Actuarial approach is more systematic.
Structured Professional Judgement Approach
Explores factors from the actuarial assessment. It is done by a systematic assessment of violence risk factors associated with the individual
Violence Risk Appraisal Guide (VRAG)
Historical Clinical Risk (HCR-20 v2)
Historical
Clinical (Present)
Future (Risk Management)