Psychiatric Services

When assessing an individual's risk of behaving violently, clinicians should consider asking the person who may know best. In this study, clinicians interviewed inpatients who had co-occurring disorders and who were considered to pose a high risk of violence. The interviewers used two well-regarded assessment tools to rate patients' potential for violent behavior. They also asked the patients to rate their own risk of violence. Patients' ratings were fairly accurate in predicting violent behavior two months after discharge and outperformed predictions based on the two assessment tools.

Assertive community treatment (ACT) is associated with an array of positive outcomes for people with serious mental illness, but reducing arrest and incarceration is not one of them. To gain a better understanding of the failure of traditional ACT models to improve criminal justice outcomes, researchers analyzed five years of data for more than 4,700 ACT clients in New York State. Clients with recent forensic histories experienced an array of adverse outcomes, particularly during their first year of ACT. Findings highlight the need for ACT teams to implement additional strategies for these high-risk clients.

Individuals with severe mental disorders who do not adhere to community-based treatments are often subject to pressures to leverage participation, including pressures related to the criminal justice system, housing, and money. In this study, researchers interviewed nearly 200 outpatients in San Francisco, 40% of whom reported experiencing leverage in the past six months. Those who reported greater coercion were more likely to report taking their medications as prescribed. But higher perceived coercion came at a cost in terms of satisfaction with care.