How Mental Illness is Related to Violence

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Over time, there seems to have been a progressive convergence of mental illness and violence in day-to-day clinical practice. From early declarations disavowing the competence of mental health professionals to predict violence, there has been a growing willingness on the part of many mental health professionals to predict and manage violent behaviour. With the advent of actuarial risk assessment tools, violence risk assessments are increasingly promoted as core mental health skills: expected of mental health practitioners, prized in courts of law and correctional settings, and key aspects of socially responsible clinical management . Many psychiatrists, particularly those working in emergency or acute care settings, report direct experiences with violent behaviour among the mentally ill. In Canada, for example, where violence in the population is low relative to most other countries, the majority of psychiatrists are involved in the management and treatment of violent behaviour, and 50% report having been assaulted by a patient at least once. However, clinical experiences with violence are not representative of the behaviours of the majority of mentally ill. Social changes in the practice of psychiatry, particularly the widespread adoption of the dangerousness standard for civil commitment legislation, means that only those with the highest risk of violence receive treatment in acute care settings. In fact, a serious limitation of clinical explanations of violent and disruptive behaviour is their focus on the attributes of the mental illness and the mentally ill to the exclusion of social and contextual factors that interact to produce violence in clinical settings. Even in treatment units with a similar clinical mix and acuity, rates of aggressive behaviours are known to differ dramatically, indicating that mental illness is not a sufficient cause for the occurrence of violence. Studies that have examined the antecedents of aggressive incidents in inpatient...
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