Mental disorder and violence in the mental health and the correctional system: : different services with overlapping challenges?

Abstract

Even though the mental health and the correctional system have been separate entities throughout the last centuries, they both deal with the deposition of aberrant behaviour. The most serious type of such behaviour is interpersonal violence, which may lead to prison incarceration or to involuntary admission in mental institutions. The interface and overlapping between populations from bed-based institutions of the two services have been studied in this thesis. The basis for the clinical studies performed was threefold; a) the type and quantity of violence among patients in parts of the Norwegian mental health system, b) the occurrence of mental symptom disorders among inmates in the entire Norwegian correctional system, and c), the development and validation of a new screening checklist for violence risk in general psychiatry.

The main aim of the thesis was the development of the screening checklist. Research through the last two decades has shown that instrument-aided violence risk assessment is definitely more helpful than clinical assessment alone, and well validated inventories for this have existed for some time in forensic psychiatry. However, these have typically been far too time-consuming for use in general psychiatry with its large number of patients. In four of the thesis’ six papers, the development and validation of a new, user-friendly brief screening checklist is described. This was performed in a material of over 1.000 patients, covering both the in- and outpatient context of acute psychiatric clinics. Results showed a good interrater reliability and further a very good predictive validity measured by ROC-analysis. A version of the screen for police and correctional work is also discussed.