Saturday, 15 January 2005 - 12:00 PM

This presentation is part of: Poster Session II

Assessing for Violence: Lessons Learned

Purpose: The perceived link between violence and serious mental illness is a major source of stigma. Adding to that are exaggerated media portrayals and sensationalistic reporting. While much research has been done on estimating the prevalence of violence within this population, little has looked at the differences between those who become violent versus those who do not. The author completed a research project to assess potential salient differences.

This paper will present a disturbing finding discovered in the course of a research project examining the differences in standards of care received by people with schizophrenia who became violent compared to those with schizophrenia who did not. During the course of recruitment for the project, many recruitment challenges were encountered. The most significant challenge (that of people being referred for the control group who had been violent in the recent past) is also a significant clinical issue.

Methods: Clinicians (case managers, psychiatrists, nurses, and/or counselors) from the referral sources (community mental health agencies) were asked to pre-screen each client chosen from a random sample of people with schizophrenia receiving services from their agency. Inclusion criteria included a DSM-IV diagnosis of schizophrenia and the absence of any violent behavior (whether or not legal charges were incurred) in the previous two years. As each referral was received, the clinician was asked to confirm that the person met inclusion and exclusion criteria and that he/she had agreed to talk to research personnel about participating.

During the course of the research interview, several people revealed information about recent violent behaviors. Screening and consent procedures needed to be modified to include direct and indirect questioning to ensure the person did not have recent violent behaviors.

Results: Forty individuals (6.6% of the total possible subjects) supposedly prescreened by their primary clinicians as not having any violent behaviors in the recent past, reported violent behaviors when directly questioned. Six of them were currently on probation for a violent offense.

Implications for Future Research and Practice: Researchers need to make sure they have several different ways to determine inclusion and exclusion criteria are met. Lack of developing different methods will result in flawed data as proper comparisons will not be possible. This is especially important in areas where the inclusion or exclusion criteria carry additional care or potential stigma (e.g. violence). In addition, it is widely known that the best predictor of future violence is past violence. Given this, researchers were surprised by the lack of awareness of these behaviors by clients’ primary clinicians. Without breaking confidentiality, clinicians were made aware of this finding and given in-service training on assessing risk factors for violence. This provides one clear example of how research can directly inform practice.

This project was funded by the Theodore and Vada Stanley Foundation.

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