Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and ViolenceThe presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work. |
Contents
| 3 | |
| 15 | |
| 37 | |
| 61 | |
| 91 | |
6 Combining Customized Risk Assessments to Produce the Best Estimate of Risk | 115 |
Assessing and Managing Risk | 129 |
Appendix A | 145 |
Appendix B | 163 |
References | 169 |
Index | 187 |
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Common terms and phrases
20 weeks actuarial African-American aggressive acts alcohol analysis antisocial behavior Appelbaum associated baseline bipolar disorder CHAID Chapter classification tree clinically feasible ICT clinicians collateral committed context crime delusions factors for violence father follow-up interviews follow-up period gender hallucinations Hare PCL:SV Hart high or low high risk hospital discharge ICT model identified Lidz logistic regression low risk MacArthur Violence Risk main effects measure mental disorder mental health mental illness Monahan Mulvey neighborhood Odds Ratio patient violence patients reported Pescosolido Postdischarge Violence predicting violence predictive accuracy prevalence prior violence psychiatric patients Psychopathy Checklist rate of violence relationship Risk Assessment Study risk category risk factors risk for violence Risk Group ROC curve schizophrenia scores Self-report question significant SIV+ standard classification tree Steadman subjects substance abuse Table Target treatment variables violence and criminality violence risk assessment violent acts violent behavior Violent Fantasies violent incidents violent thoughts WPIC