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Abstract
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This article describes the perceived bases for determinations of dangerousness regarding a representative sample of patients, primarily insanity acquittees, confined on the grounds of "dangerousness" (and mental disorder) at a secure forensic facility. Accordingly, the article seeks to elucidate various considerations that often are -- and perhaps should be -- involved in clinical assessments of dangerousness regarding the population under consideration, and the various forms by which perceived -- and judicially determined -- dangerousness manifested itself in the study population. Some possible implications of the findings for certain policies regarding the confinement of mentally disordered individuals -- particularly insanity acquittees -- on the grounds of "dangerousness" are also discussed.
VioLit summary:
OBJECTIVE:
This aim of this study by Litwack was to describe the perceived "dangerousness" of a representative sample of mental patients, legally confined on the basis of their presumed dangerousness.
METHODOLOGY:
The author conducted a quasi-experimental study. The study was set at a large, secured hospital that housed criminals who had been found not guilty by reason of insanity. The sample consisted of 50 patients from the three wards that were set aside for actively dangerous patients. Dangerousness was operationally defined as a quality of someone who posed, "a definite likelihood of serious violence if not restrained" (p. 100).
First, the author met with the professional leaders of each ward and found out who they recommended as the staff member with the most knowledge of each wards patients. Then, he met with each of these staff members and obtained preliminary descriptions of why each patient had been labeled dangerous. Next, the author looked at each patient's chart. In the charts were psychiatric evaluations that specifically addressed the issue of dangerousness. He attended evaluations by the professional ward teams for those patients who had unclear bases for being considered dangerous.
The author used descriptive statistics to analyze the data. Also, brief case histories are included to describe each patient and why that patient is placed into different categories of dangerousness.
FINDINGS/DISCUSSION:
The author reported that 28% of the sample fit the author's opinion of presenting a serious threat of violence. The author found that 6% of the sample exhibited a threat of lesser violence. Therefore, 18 out of 50 patients were determined to be a certain threat of violence if released. The author evaluated 10% of the patients posed a serious, although not repetitive, threat of violence. Then, 24% of the patients presented an unspecifiable risk of violence to self or others. Only 8% of the patients were perceived as being safe to transfer to a nonsecure facility. Finally, 20% of the patients were characterized as posing a low risk to commit violence because they exhibited some psychological improvements.
AUTHOR'S RECOMMENDATIONS:
The author recommended that legal scholars investigate the appropriateness of acquitting on the basis of insanity. The author suggested that future researchers conduct further evaluations of dangerousness. Finally, the author asked policy-makers to research the costs and benefits of fixed versus adaptable sentences for the criminally insane.
EVALUATION:
In general, this study provides some illustrative findings on dangerous mental patients. There is more description than substantial findings. The author's rankings of the different types of patients lacks clear operational definitions for the varying degrees of "dangerousness." The generalizability of this study is limited by sample bias caused by a lack of random sampling. Internal validity is questionable because the author admittedly did not assess the accuracy of the clinicians' assessments. In conclusion, this study offers a detailed and comprehensive description of a particular group of dangerous of mental patients. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - Adult Offender
KW - Psychological Evaluation
KW - Mental Health Institution
KW - Mental Illness
KW - Adult Violence
KW - Mentally Ill Offender
KW - Adult Patient
KW - Patient Violence
KW - Dangerousness Prediction |