The assessment and management of risk and susceptibility of violence in the patients with mental disorders residing in psychiatric hospitals have been extensively debated over the past many years. Some mental disorders and a few specific genetic factors have proven to modify the risk associated with violence. Skills for precise evaluation and management of risks are essential for psychiatrists and other clinicians involved in the treatment of mental disorders, to prevent undesirable results. Historically, risk assessment has been conducted basis the evaluators’ clinical impressions.
Despite the recent development and breakthroughs in the field of risk assessment, there has been a foreseeable risk of erroneous estimation of future violence. 4 techniques are principally used in risk management: monitoring, supervision, treatment, and victim protection. A recent trend in this field is bearing in mind protective factors, and some useful tools focused on this have been introduced in clinical setting. In future, biological factors may be integrated into risk assessment and estimation of treatment response.
The assessment and management of risk for violence presents significant disputes for forensic mental health practitioners. Mentally Disordered Offenders (MDOs) are subjects of psychiatry, and psychiatric nurses are therefore exposed to a high risk of persecution. In addition, accurate inference of risk and effective intrusion for the risk of violence, are necessary to proceed towards the deinstitutionalization of patients with mental disorders. Despite some opinions opposing the involvement of psychiatrists in violence risk management, mental health practitioners are expected to evaluate the risk of violence and estimate the necessity of confinement for patients with mental disorders. Ultimately, mental health practitioners need to develop skills to evaluate and manage the risk of untimely death of the patients and of others in the patients’ environment through risk assessment.
Risk management refers to the process of ameliorating a patient’s predisposition for violence to reduce the risk of unwanted outcomes.
There are several biological factors pertinent to the materialization of violence. The amygdala plays a crucial role in impetuosity, alongside the hypothalamus and prefrontal cortex. Prompting of the anterior, lateral, ventromedial, and dorsomedial nuclei in the hypothalamus causes hostility. The amygdala deregulates dread and disquiet, also resulting in violent behavior. Prefrontal cortex dysfunction can also lead to irresponsible & aggressive behavior.
Some neuro chemical transmitters also control aggression. Low serotonin and gamma-aminobutyric acid are linked with impulsivity. In addition, high doses of nor-adrenaline, acetylcholine, and dopamine are likely to cause aggression. Congenital / hereditary factors have also been under focus in relation to aggressive behavior. Also, currently, psychotic symptoms are widely considered to be associated with an increased likelihood of violence.
Structured Professional Judgment (SPJ), a process of risk assessment that is currently prevailing as the chief method of risk assessment, emphasizes on the importance of both static and dynamic factors of the subjects, and has overcome the shortcomings of both unstructured clinical judgment and actuarial risk assessment.
Risk assessment and management are essential tasks for forensic psychiatrists and other mental health professionals who operate in psychiatric hospitals or in other such IPD settings. General psychiatric practitioners can often be involved in this challenging work, as unavoidably. Thus, precise and well-balanced risk assessment methods are needed to efficiently tackle & avert the risk of violence at psychiatric hospitals.
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