Introduction

Understanding Risk, Needs, and Responsivity

Assessing an individual's propensity for risk of reoffense is a critical component of managing offenders most effectively in the community.  Criminological research shows convincingly that recidivism is reduced – and offenders are more stable and successful – when three core principles of correctional intervention – risk, needs, and responsivity – are  followed (see, e.g., Andrews & Bonta, 2007; Cullen & Gendreau, 2000):

What Do We Know about Mental Illness and Violence?

The connection between mental illness and violence is complex. Although some subgroups of people with serious mental illnesses have a higher risk of violence, including those with co-occurring substance use disorders or active psychosis, most people with mental illnesses are not violent, and most people who are violent are not mentally ill. Studies show that people with psychiatric diagnoses who have co-occurring substance use disorders or untreated symptoms of psychosis, which means their contact with reality is lost or highly distorted, have an increased risk of violence.

Correlation does not imply causation. Serious mental illness alone does not cause violence; factors other than mental illness itself (e.g., substance abuse, age, gender, socioeconomic status) can relate to violent behavior. A person with a mental illness who is not abusing substances and is adhering to treatment is no more dangerous than his or her neighbor.

Individuals with mental illness are more likely to be victims of violence than perpetrators of violence. People with serious mental illnesses are anywhere from 2.5 times to nearly 12 times more likely to be victims than perpetrators. When individuals with mental illness are perpetrators, violence committed against strangers is rare. Those most likely to be the targets of violence by a person with or without a mental illness are family members and friends who are in their own homes or in the individual's home.

Violence in a person with a mental illness cannot be predicted. Despite knowledge of identified risk factors for individuals with mental illnesses as a group, we cannot accurately predict when any one individual will be violent. While relevant assessment instruments do exist, their ability to predict future violent acts is hampered by the complex nature of violence and limited support for the instruments' use. One limitation to violence risk assessments is the fact that generally they do not indicate why a person is high or low risk (however, even knowledge of a factor that increases risk cannot necessarily be used to prevent a violent incident. Screening individuals who have acknowledged risk factors—including a past history of violent behavior—is becoming more common. However, it may never be possible to predict with certainty when any individual—with or without a mental illness—will commit a violent act.

Reducing the risk of violence is possible. While nothing can prevent all acts of violence among people with serious mental illnesses. However, the risk for violence can be reduced by 1.) addressing co-occurring substance use disorders (e.g., providing access to integrated mental health and substance abuse treatment at the same time and in the same treatment setting); and 2.) providing access to certain treatments that have demonstrated effectiveness in violence reduction generally (e.g., cognitive behavioral therapy).

(Adapted with Permission from Responding to a High-Profile Tragic Incident Involving a Person with a Serious Mental Illness from the Justice Center at the Council of State Governments, available at: http://csgjusticecenter.org/cp/publications/responding-to-a-high-profile-tragic-incident-involving-a-person-with-a-serious-mental-illness/)


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Assessing Risk to Reoffend and
Propensity for Violence
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