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Nearly three times as many people detained in a jail have a serious mental illness (SMI) when compared to community samples. Once an individual with SMI gets involved in the criminal justice system, they are more likely than the general population to stay in the system, face repeated incarcerations, and return to prison more quickly when compared to their nonmentally ill counterparts.
Inpatient aggression within psychiatric facilities continues to demand attention. Aggressive acts often cause physical or psychological injury that impact the lives of the patients or staff victims of these incidents. However, it should be noted that the vast majority of psychiatric patients are not aggressive while hospitalized. Studies on inpatient aggression showed approximately 25%–35% of inpatients committed acts of aggression. For those inpatients who are aggressive, there is a substantial literature that that describes a small subset of “chronically aggressive” patients, who are responsible for the majority of inpatient aggression.
The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.
Historically, patients with multiple acts of aggression, or chronic aggressors, have been studied as one large group. It was our objective to subdivide this group into those patients who engage in physical aggression consistently over multiple years and see if common characteristics of chronic aggressors could classify patients into an aggressive or nonaggressive group.
Within a forensic hospital system, patients who had committed 5 acts of physical aggression, per year, for 3 years (2010 and 2015) were reviewed. Data was collected on clinical and demographic characteristics that have shown to be associated with chronically aggressive patients and compared to nonaggressive matched controls. Data collection and analysis were completed to determine if the variables could classify patients into an aggressive or nonaggressive group.
Analysis showed that 2 variables, the presence of a cognitive disorder and a history of suicidal behaviors were significant in the univariate and multivariate analyses. The 2 variables were able to correctly classify 76.7% of the cases.
A cognitive disorder, a history of suicidal behavior, and increased age were factors associated with this subgroup of aggressive patients. Clinicians may want to explore treatment programs aimed at these clinical factors including cognitive rehabilitation and social cognition treatments, which have been shown to reduce aggression in cognitively impaired populations.
In May 1722 Johann Mattheson published the inaugural issue of Critica musica, the first known periodical devoted to music criticism. Focusing on the appraisal of music theory, this journal defined the purpose of criticism as ‘for the most feasible uprooting of all coarse errors and the promotion of a better growth of the pure harmonic science’. Mattheson used the metaphor of an overgrown garden to convey his belief that critics should weed out musical faults: ‘I have become somewhat severe about the beautiful musical garden, and will not fail to uproot the old, deep-rooted, stiff, prickly, wild, barbaric briars.’ He explained that the regular rhythm of periodical publication suited his critical mission to shape wider opinion: ‘In today’s lifestyle only rarely will people read a whole book, but they will more readily read through a few pages every month. In this format the [critical] onslaught is always new, and, like a steady drip of water, is able finally to make holes here and there in the rock.’