Steadman et al

Steadman et al - ORIGINAL ARTICLE Violence by People...

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Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods Henry J. Steadman, PhD; Edward P. Mulvey, PhD; John Monahan, PhD; Pamela Clark Robbins, BA; Paul S. Appelbaum, MD; Thomas Grisso, PhD; Loren H. Roth, MD; Eric Silver, MA Background: The public perception that mental dis- order is strongly associated with violence drives both le- gal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of commu- nity violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed. Methods: We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hos- pital. Patient self-reports were augmented by reports from collateral informants and by police and hospital rec- ords. The comparison group consisted of 519 people liv- ing in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. Results: There was no significant difference between the prevalence of violence by patients without symptoms of sub- stance abuse and the prevalence of violence by others liv- ing in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symp- toms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at fam- ily members and friends, and most often took place at home. Conclusions: “Discharged mental patients” do not form a homogeneous group in relation to violence in the com- munity. The prevalence of community violence by people discharged from acute psychiatric facilities varies con- siderably according to diagnosis and, particularly, co- occurring substance abuse diagnosis or symptoms. Arch Gen Psychiatry. 1998;55:393-401 F OR 75 YEARS, studies have at- tempted to estimate the prevalence of violence com- mitted by people discharged from psychiatric facilities in the United States, and to compare that rate with the prevalence of violence by others in their communities. 1-3 These studies have been invoked in legal and policy debates concerning standards for hospital admis- sion and discharge, for community place- ment and monitoring, and for tort lia- bility. 4
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Steadman et al - ORIGINAL ARTICLE Violence by People...

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