37 Crim. Just. & Behavior 5 (2010)

handle is hein.journals/crmjusbhv37 and id is 1 raw text is: 



Prevalence, Description, and Identification

Simon Fraser University
BC Mental Health and Addiction Services, University ofBritish Columbia, and Simon Fraser University
Simon Fraser University, BC Mental Health and Addiction Services, and University ofBritish Columbia

This study examines the prevalence and the individual characteristics of chronically violent patients (CVPs) in a psychiatric
hospital during inpatient treatment. The study is based on a 1-year follow-up investigation of all violent episodes committed
by a sample of 527 patients in a forensic psychiatric hospital in British Columbia, Canada. Sociodemographic, legal and
criminological, historical, and clinical factors were analyzed using a risk assessment scheme. Approximately 10% of the
sample was responsible for more than 60% for all violent episodes recorded during the study period. Those CVPs were
characterized by historical, but mostly clinical, risk factors. Moderate to good predictive accuracy was achieved when defin-
ing CVPs as individuals who perpetrated 15 or more violent episodes. Important limitations of the actuarial approach were
also highlighted by the presence of two qualitatively different groups of CVPs. The results are discussed in light of the sci-
entific literature on the risk management of inpatient violence.

Keywords: risk assessment; inpatient; aggression; violence; chronic violent patients; psychiatric units

In   recent years, the perpetration of violence  by psychiatric  patients during inpatient treat-
   ment  has received  considerable  attention. These manifestations  often result in short-term
and  long-term psychological   suffering, physical injury, medical and legal expenses,  and gen-
eral distress for the staff and patients (Flannery, 2002; Johnson,   2004). Concerns   about the
consequences   of violence  against staff and copatients  led to the proliferation of prevention
and  intervention strategies to modify  and decrease  the risk of violence (Livingston, Verdun-
Jones, Brink,  Lussier, & Nicholls, in press). This proliferation has been  accompanied   by the
emergence of actuarial tools to screen violent patients. These tools, however, have been
developed   to screen violent recidivism  following  prison release or hospital  discharge (e.g.,
Quinsey,  Harris, Rice, &  Cormier,   1998). The  distinction between  violence  during hospital

AUTHORS' NOTE: The authors are grateful   for the financial support provided by BC Mental Health and
Addiction Services. The authors wish to thank Dr. Curt R. Bartol and several anonymous reviewers for their
thoughtful comments. An earlier version of this study was presented at the annual meeting of the Canadian
Psychiatric Association in Toronto (November 2006). Please address correspondence to Patrick Lussier, PhD,
School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
V5A  1S6; e-mail: plussiersfu.ca.

CRIMINAL JUSTICE AND BEHAVIOR, Vol. 37 No. 1, January 2010 5-28
DOI: 10.1177/0093854809347738
0 2010 International Association for Correctional and Forensic Psychology


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