Chief complaint: Homicidal. Assessing violence risk
A structured approach can help identify risk factors, including those not due to mental illness.
Steadman et al28 compared 1,136 adult patients with mental disorders discharged from psychiatric hospitals with 519 individuals living in the same neighborhoods as the hospitalized patients. They found that the prevalence of violence among discharged patients without substance abuse was “statistically indistinguishable” from the prevalence of violence among community members, in the same neighborhood, who did not have symptoms of substance abuse.28 Swanson et al6 found that the combination of a mental disorder plus an alcohol or substance use disorder substantially increased the risk of violence.
Other dynamic risk factors for violence include mental illness symptoms such as psychosis, especially threat/control-override delusions, where the individual believes that they are being threatened or controlled by an external force.17
Contextual factors to consider in violence risk assessments include current stressors, lack of social support, availability of weapons, access to drugs and alcohol, and the presence of similar circumstances that led to violent behavior in the past.5
How to assess the risk of targeted violence
Targeted violence is a predatory act of violence intentionally committed against a preselected person, group of people, or place.29 Due to the low base rates of these incidents, targeted violence is difficult to study.7,30 These risk assessments require a more specialized approach.
Continue to: In their 1999 article...
