Ebook: Violence among the Mentally III: Effective Treatments and Management Strategies

The NATO Advanced Study Institute on the Prevention of Crime and Violence Among the Mentally III was held in May 1999 in Tuscany, Italy. Participants from 15 countries attended. Since care for persons with mental illness (schizophrenia, major depression, bipolar disorder, delusional disorder, atypical psychoses) has been deinstitutionalized, some persons with these disorders are committing crimes and serious violence. Consequently, societies around the world are confronted with a new challenge: to provide mental health care and social services to mentally ill persons in a humane way that will prevent illegal behaviours. Research in this field has been dominated by investigations designed to improve clinicians' accuracy in predicting violent behaviours, with little attention focused on the organization and implemen­ tation of treatments. The premise of the Advanced Study Institute was that treatments must have em­ pirically proven efficacy. Both professional ethics and public accountability require empirical evidence that each treatment will alleviate the problem that it targets. However, despite the fact that Western industrial societies provide treatment for mentally ill persons who have offended, there is a very limited base of knowledge on what constitutes effective treatment and how such treatments should be organized and delivered. The Advanced Study Institute was an attempt to stimulate and encour­ age research that will extend this knowledge base. The goals were to review what is known about mentally ill offenders and about effective treatments for them, and to provide a framework for the orientation of future investigations designed to improve treatment efficacy.

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The book, written by some of the leading researchers in the world in the field of mental illness and crime, starts by reviewing investigations of crime and violence by the mentally ill in the community, in hospitals and in correctional facilities. It goes on to review the development of offending and violent behaviour among persons with mental illness. Subsequent chapters document what is known about the effective prevention of offending and violent behaviour among the mentally ill. The provision of treatment in the community, in hospitals and correctional facilities is then critically reviewed and discussed, with specific descriptions of pharmacological and behavioural treatments. Compliance with treatment is discussed at length. Methodological issues in measuring the effectiveness of treatment of mentally ill offenders are described, with recommendations for future studies to evaluate treatments.