Capturing Change: An Approach to Managing Violence and Improving Mental Health

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Risk Assessment, Personality Disorder, Violence Risk, Violence Risk Assessment, Forensic Patient

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Recently colleagues of ours discoursed on the topic of treatment effectiveness as it relates to persons with serious mental and personality disorder (Harris & Rice, 1997). They introduced their piece by pointing out that, although they had never encountered a fully effective intervention programme, they would in all likelihood recognize one such if they were to see it. Our present outlook is similar to that of Harris and Rice but goes a step further. We suggest that even if a programme is actually effective, chances are that behavioural and attitudinal changes will be indexed so haphazardly, if at all, that they will not be captured and so will not enter the record. And if positive changes are not pinned down during treatment or intervention the result can be to the great detriment of the individual patient, prisoner, or parolee. By the same token, if absence of changes or negative changes are not taken into account, innocent members of society can be placed at risk for violence. It will be argued here that, despite the almost mesmerizing abundance of validated, semi-validated, and unvalidated tests and scales for risk assessment on the market, there exist in fact few clinically relevant, procedurally fair devices for measuring changes in risk-relevant “dynamic” factors on an interdisciplinary basis. This would apply to measurements both in institutions and in the community. We would also like to posit that serious attempts to document dynamic changes could very possibly have salutary effects, meaning that the mere focus on indexing changes may play an important if minor role in inducing them.


978-0-7923-6438-2 (Print) 978-94-011-4130-7 (Online)

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Violence Among the Mentally III, v. 90, p. 119-144