Violence and Mental Health Opportunities for Prevention and Early Detection: Proceedings of a Workshop (2018) / Chapter Skim
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3 At the Intersection of Mental Health and Violence
3 At the Intersection of Mental Health and Violence
Pages 21-34
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From page 21... ...
EXPERIENCES AND PERSPECTIVES RELATED TO MENTAL HEALTH AND VIOLENCE Daniel Fisher of the Riverside Community Mental Health Center opened the panel titled "Experiences and Perspectives Related to Mental Health and Violence" by describing the importance of language. He noted that "patient" and "consumer" are not preferred terms within the community, and "survivor" is imprecise, and he suggested "people with lived experience" as a more inclusive and less discriminatory term.
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1 This section summarizes information presented by Elyn Saks, University of Southern California.
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From page 23... ...
The stigma and the misinformation around the role mental illness plays in violence is often heightened after incidents of mass violence, with resounding repercussions. Rosenthal mentioned that policies are often promoted in government that seek to respond to these incidents, but instead result in depersonalization and 2 This section summarizes information presented by Harvey Rosenthal, New York Associa tion of Psychiatric Rehabilitation Services, Inc.
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From page 24... ...
And others consider sociopathy and substance abuse to be mental illnesses. At the same time, the common perception that one must be "crazy" to commit horrific acts confuses matters further and feeds into the misperception that mental illness is a risk factor for violence.
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However, he was careful to point out that integration of patients with communities was intended to be accompanied by a comprehensive community mental health movement, in which services are community based rather than hospital based. Yet, this movement never materialized, and as a result of poor funding, the mental health domain today exists as a crisis system.
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Caine went on to note that, previously, community mental health fell under the purview of the National Institute of Mental Health, but currently the Substance Abuse and Mental Health Services Administration (SAMHSA) provides block grants to states, with individual counties developing systems and allocating funds.
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Assessments that combine elements of structured and unstructured approaches, such as actuarial instruments to calculate a probability score, or categorizing risk as high, medium, or low based on a predetermined checklist of risk factors, are commonly used. Fazel and his colleagues examined the literature and located 40 systematic reviews and meta-analyses on commonly used tools to determine their evidence base.
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Universal interventions are delivered to an entire population of youth, while selected programs target youth with population-level or demographic risk factors, such as living in a high-crime neighborhood. Indicated interventions, which represent a large percentage of interventions, focus on children who exhibit early forms of violent behavior, such as physical fighting, or characteristics of oppositional defiant disorder and conduct disorder.
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From page 29... ...
There are a few ad hoc tools, but none that are available for the general population. These ad hoc tools are based on the idea that early conduct problems are strong predictors for future violent behavior, an association seen in longitudinal studies.
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He proposed examining multiple datasets across the country and conducting comparable analyses to replicate factors measured by parents, teachers, and the children themselves. Once they have identified those factors that consistently predict violence, they plan to d evelop standardized item content to assess each risk domain.
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He emphasized the importance of this by noting that, by comparison, obesity, which commands significant resources for its prevention, only accounts for 3 percent of heart attacks. Other research supports similar findings; another study found that chronic bullying before age 11 increases risk of psychotic experiences threefold (Wolke et al., 2014)
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Discussion In response to questions regarding mental illness risk factors for youth violence, Pardini noted that the main driving predictors are conduct disorders and oppositional defiant disorder; others, such as depression and anxiety, do not have a strong relationship. Additionally, when he and his colleagues analyzed other potential factors, such as trauma and physical abuse and neglect at home, they were also not as significant in predicting future violent behavior.
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From page 33... ...
2005. Violent juvenile sex offenders compared with violence juvenile nonsex offenders: Explorative findings from the Pittsburgh Youth Study.
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