Violence Risk Reduction Planning

Whilst the murder rate in the United States is down as a whole the mass murder rate has been rising (USA Today, 2014).  Many have been broadcasting the fact that we are seeing an overall decline in the murder rate in this country but, it is still a fact that, the United States has the highest violence and incarceration rates of all advanced nations in the world according to the World Health Organization. How to we deal with this issue when many have tried and failed in the past? We need to move the conversation down a direction that it has not gone before; we are in grave need of Violence Reduction Plans.

Whether a person’s problems are behavioral, mental, substance abuse related, or legal, those who have the most complex array of Violence Risk Factors and the least effective coping skills are more likely to commit violence when under severe stress.  It is very easy to make a list of commonly agreed upon Violence Risk Factors and screen people with serious problems for those risk factors. An article by Joel A. Dvoskin, PhD, and Kirk Heilbrun, PhD in the Journal of the American Academy of Psychiatry Law (2001) recommends that Risk Reduction Models be added to the present field of Risk Assessment and Prediction. This is absolutely correct and needs to happen without delay.

This raises at least two issues:

• Why is everyone not using a validated Violence Risk-Screening Tool? This means schools, colleges, police, doctors, mental health outpatient facilities, hospitals, criminal justice, social services, and juvenile services should have the capacity to screen for violence risk factors.
• What does one do when you find someone with multiple risk factors for violence? A Violence Risk Reduction Model must be applied.  The research on these models is sparse, but becoming more and more important.

The Examples Keep Coming

In 2001, David Attias, screamed, “I am the Angel of Death” as he mowed down pedestrians with his car on a crowded Isla Vista Street.  He was declared insane and now resides in a mental hospital. It is assumed he will be in the hospital until he is no longer a danger to himself or others. But how do people know when that is?  The truth is they cannot be sure unless they use a valid Risk Reduction Planning Tool.

On May 21, 2014, police arrested Carol Coronado on suspicion of stabbing her three young daughters to death at their home in Los Angeles County. Carol allegedly called her mother and said she thought that she was going crazy. The children’s grandmother rushed to the house and discovered the children lying on a bed with their mother. The three small girls were already dead. Did anyone know that this woman was struggling? Did they know what to do to help her?

Peter Rodger, Assistant Director of the Hunger Games movies, through his attorney, has tentatively identified the May 24, 2014 Isla Vista mass murderer as his son, Elliott. He also stated that he reported his son’s disturbing YouTube retribution rant to police before the rampage.  Police interviewed Elliott days before the shootings and found him to be intelligent, polite, and pleasant. He has since passed away so we do not have to worry about the risk of recidivism when he gets out of jail. However, I am sure there are other youth out there that are just as disturbed as this young man. They need to be found and interventions need to be put in place before murders take place. I am not talking about incarceration; I am talking about treatment for very disturbed people.

Violence Risk Reduction Planning

There are two groups of (mostly, but not always) young men (age 15–40) at risk for violence:

– Mentally ill or on the spectrum youth
OR
-Those with anti-social traits that have been chronically violent since childhood.

The risk factors are different for those two groups.

The Mentally Ill Group or Erupter Group are Often:

–        Socially Awkward

–        Narcissistic

–        Very Intelligent

–        Lacking in Social Support

–        Paranoid

–        Exhibiting Signs of a Personality Disorder

–        Not Actively Engaged in Treatment

–        Having School or Home or Work Difficulties

–        Having Difficulties Getting Along with Others

–        Exhibiting Poor Anger-Management

–        May be Abusing Substances

–        Showing Low-Frustration Tolerance

–        Having a History of Past Emotional Outbursts

–        Mood Disorder

–        Autism-Spectrum Disorders.

The more of these risk factors a person has, the more likely it is that the person should receive risk reduction interventions that include: family therapy; skill building; high intensity services; support; coaching; help in a troubling environment; mental health treatment; positive activities; and positive social interactions.

The Chronically Violent Group may have:

–        Deviant Peers

–        History of Childhood Trauma

–        History of Past Violence

–        Prior Bullying Experience

–        Difficulty in School or Work

–        Inappropriate Disciplinary Practices by Parents

–        Paranoia

–        Mental Illness

–        Substance Abuse

–        Impulsivity

–        Delinquent or Criminal Behavior

–        Lack of Remorse

–        Anger-Management Problems

–        Poor Problem-Solving Skills

–        Very Poor Social Skills

–        Neurological Impairment

–        Not Complying with Treatment

–        A Recent Stressful Event

–        Lack of Adequate Support

–        Frequent Absences from School or Work

Again, the more of these Risk Factors a person has, the more likely an intensive intervention is needed to head off a bad outcome.

Evidence-based treatment for youth with severe behavior problems is family therapy (Lipskey), wrap around services, developmentally appropriate skill building (Braaten), multi-systems services, intensive services, substance abuse screening, treatment for all family members, and mental health screening.

This seems like a huge task and budgets are tight. However, we have the most violent country and the highest incarceration rate among ALL industrialized nations.  We are also one of the few industrialized nations to still have capital punishment.  It will take a paradigm shift, not huge amounts of new money, to stem the tide of United States violence.  Community treatment is much more cost effective than no treatment in prison and ending up with a 60–80% recidivism rate. This cannot continue and we need to implement change immediately instead of continuing down the never-ending path we are on now.

Author: Kathryn Seifert, Ph.D., author of the Child & Adolescent Risk Evaluation screening tool

Source: PsychologyToday