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Section 1 - Statement of the problem

Published online by Cambridge University Press:  19 October 2021

Katherine D. Warburton
University of California, Davis
Stephen M. Stahl
University of California, San Diego
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Publisher: Cambridge University Press
Print publication year: 2016

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Torrey, EF, Miller, J. The Invisible Plague: The Rise of Mental Illness from 1750 to the Present. New Brunswick, NJ: Rutgers University Press; 2002.Google Scholar
NIMH website. Prevalence of serious mental illness among U.S. adults by age, sex, and race. SMI_AASR.shtml.Google Scholar
Olfson, M, Marcus, SC, Doshi, JA. Continuity of care after inpatient discharge of patients with schizophrenia in the Medicaid program: a retrospective longitudinal cohort analysis. J. Clin. Psychiatry. 2010; 71(7): 831838.CrossRefGoogle ScholarPubMed
Torrey, EF. American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System. New York: Oxford University Press; 2014.Google Scholar
Testimony of Dr. Andrew Robertson before the Select Committee on Proposed Phaseout of State Hospital Services, May 18–October 10, 1973, California State Archives.Google Scholar
Grunberg, F, Klinger, BL, Grumet, B. Homicide and deinstitutionalization of the mentally ill. Am. J. Psychiatry. 1977; 134(6): 685687.Google Scholar
Grunberg, F, Klinger, BL, Grumet, BR. Homicide and community-based psychiatry. J. Nerv. Ment. Dis. 1978; 166(12): 868874.CrossRefGoogle Scholar
Rabkin, J. Criminal behavior of discharged mental patients: a critical appraisal of the research. Psychol. Bull. 1979; 86(1): 127.CrossRefGoogle Scholar
Kuhlman, TL. Unavoidable tragedies in Madison, WI: a third view. Hosp. Community Psychiatry. 1992; 43(1): 7273.Google Scholar
Karra, A, Otis, DB. A comparison of inpatients in an urban state hospital in 1975 and 1982. Hosp. Community Psychiatry. 1987; 38(9): 963967.Google Scholar
Swanson, JW, Hozer, CE 3rd, Ganju, VK, Jono, RT. Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hosp. Community Psychiatry. 1990; 41(7): 761770.Google Scholar
Wilcox, DE. The relationship of mental illness to homicide. American Journal of Forensic Psychiatry. 1985; 6(1): 315.Google Scholar
Steinwachs, DM, Kasper, JD, Skinner, EA. Family Perspectives on Meeting the Needs for Care of Severely Mentally Ill Relatives: A National Survey. Arlington, VA: National Alliance for the Mentally Ill; 1992.Google Scholar
Link, BG, Andrews, H, Cullen, FT. The violent and illegal behavior of mental patients reconsidered. American Sociological Review. 1992; 57(3): 275292.CrossRefGoogle Scholar
Monahan, J. Mental disorder and violent behavior: perceptions and evidence. American Psychologist. 1992; 47(4): 511521.CrossRefGoogle ScholarPubMed
Bartels, J, Drake, RE, Wallach, MA, Freeman, DH. Characteristic hostility in schizophrenic outpatients. Schizophr. Bull. 1991; 17(1): 163171.CrossRefGoogle ScholarPubMed
Hempel, AG, Meloy, JR, Richards, TC. Offenders and offense characteristics of a nonrandom sample of mass murders. J. Am. Acad. Psychiatry Law. 1999; 27(2): 213225.Google Scholar
Fessenden, F. They threaten, seethe and unhinge, then kill in quantity. New York Times, April 9, 2000, pp. 1 and 20.Google Scholar
Talbott, JA. Deinstitutionalization: avoiding the disasters of the past. Hosp. Community Psychiatry. 1979; 30(9): 621624.Google ScholarPubMed
Fazel, S, Gulati, G, Linsell, L, Geddes, JR, Grann, M. Schizophrenia and violence: review and meta-analysis. PLoS Med. 2009; 6(8): e10000120.CrossRefGoogle ScholarPubMed
Fazel, S, Wolf, A, Palm, C, Lichtenstein, P. Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. Lancet Psychiatry. 2014; 1(1): 4454.CrossRefGoogle ScholarPubMed
Witt, K, van Dorn, R, Fazel, S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS ONE. 2013; 8(2): e55942.CrossRefGoogle ScholarPubMed
Van Dorn, R, Volavka, J, Johnson, N. Mental disorder and violence: is there a relationship beyond substance abuse? Soc. Psychiatry Psychiatr. Epidemiol. 2012; 47(3): 487503.CrossRefGoogle Scholar
Short, T, Thomas, S, Mullen, P, Ogloff, JR. Comparing violence in schizophrenia patients with and without comorbid substance-use disorders to community controls. Acta Psychiatr. Scand. 2013; 128(4): 306313.Google Scholar
Matejkowski, JC, Cullen, SW, Solomon, PL. Characteristics of persons with severe mental illness who have been incarcerated for murder. J. Am. Acad. Psychiatry Law. 2008; 36(1): 7486.Google ScholarPubMed
Follman, M, Aronsen, G, Pan, D. A guide to mass shootings in America. Mother Jones, December 15, 2012.Google Scholar
Swanson, JW, Swartz, MS, Essock, SM, et al. The social–environmental context of violent behavior in persons treated for severe mental illness. Am. J. Public Health. 2002; 92(9): 15231531.CrossRefGoogle ScholarPubMed
Elbogen, EB, van Dorn, RA, Swanson, JW, Swartz, MS, Monahan, J. Treatment engagement and violence risk in mental disorders. Br. J. Psychiatry. 2006; 189(4): 354360.CrossRefGoogle ScholarPubMed
Elbogen, EB, Mustillo, S, van Dorn, R, Swanson, JW, Swartz, MS. The impact of perceived need for treatment on risk of arrest and violence among people with severe mental illness. Criminal Justice and Behavior. 2007; 34(2): 197210.CrossRefGoogle Scholar
Fazel, S, Zetterqvist, J, Larsson, H, Långström, N, Lichtenstein, P. Antipsychotics, mood stabilisers, and risk of violent crime. Lancet. 2014; 384(9949): 11671168.Google ScholarPubMed
Nielssen, O, Large, M. Rates of homicide during the first episode of psychosis and after treatment: a systematic review and meta-analysis. Schizophr. Bull. 2010; 36(4): 702712.CrossRefGoogle ScholarPubMed
Torrey, EF. The Insanity Offense. New York: W.W. Norton; 2008.Google Scholar
Burns, T, Rugkasa, J, Molodynski, A, et al. Community treatment orders for patients with psychosis (OCTET): a randomized controlled trial. Lancet. 2013; 81(9878): 16271633.CrossRefGoogle Scholar
O’Keefe, C, Potenza, DP, Mueser, KT. Treatment outcomes for severely mentally ill patients on conditional discharge to community-based treatment. J. Nerv. Ment. Dis. 1997; 185(6): 409411.CrossRefGoogle ScholarPubMed
Lamb, HR, Weinberger, LE. Mental health courts as a way to provide treatment to violent persons with severe mental illness. JAMA. 2008; 300(6): 722724.CrossRefGoogle ScholarPubMed
Steadman, HJ, Redlich, A, Callahan, L, Robbins, PC, Vesselinov, R. Effect of mental health courts on arrests and jail days: a multisite study. Arch. Gen. Psychiatry. 2011; 68(2): 167172.CrossRefGoogle ScholarPubMed


Finz, S, King, J. Napa State Hospital psychiatric worker slain. San Francisco Chronicle. October 25, 2010. article/Napa-State-Hospital-psychiatric-worker-slain-3248688.php.Google Scholar
Cohn, M, Walker, AK. Treatment problems, fear found in state’s high-security mental hospital, workers say. Baltimore Sun. November 7, 2011. health/bs-hs-perkins-fear-20111107_1_patients-maximum-security-psychiatric-hospital-susan-sachs.Google Scholar
Violence and fear in state mental hospitals on the rise nationally. Baltimore Sun. November 24, 2011. Scholar
Our View: Forensic patients swamp state mental hospital. Portland Press Herald. August 25, 2013. = full.Google Scholar
Poindexter, R. DHHS Commissioner blames growth in court ordered patients for Riverview problems; urges passage of LePage’s plan. WABI TV5. August 22, 2013. dhhs-commissioner- blames-growth-in-court-ordered-patients-for-riverview-problems-urges-passage-of-lepages-plan/.Google Scholar
Biscobing, D, LaMet, M. ABC 15 investigation exposes a ‘shocking’ level of violence at the Arizona State Hospital. ABC15 Arizona. August 9, 2013. Scholar
Ryan, J. Violence on the rise at Western State Hospital. Northwest Public Radio. May 3, 2012. Scholar
Ball, A. Patient violence jumps at state psychiatric hospitals. January 26, 2013. Scholar
Rector, K. Assaults on staff are focus of scathing report at Catonsville Psychiatric Hospital. Baltimore Sun. March 2, 2013. catonsville/bs-md-co-spring-grove-report-20130302,0,7658971.story.Google Scholar
Hegedus, N. Danger at Mid-Hudson Psych: ‘I’m just waiting for a staff member to come out dead.’ Times-Herald Record. Undated. Scholar
Romney, L. State mental hospitals remain violent, despite gains in safety. Los Angles Times. October 9, 2013. Scholar
Jaffe, I. Violence at Calif. mental hospitals: ‘this is the norm.’ NPR. July 21, 2011. violence-at-calif-mental-hospitals-this-is-the-norm.Google Scholar
Anderson, A, West, SG. Violence against mental health professionals: when the treater becomes the victim. Innov. Clin. Neurosci. 2011; 8(3): 3439.Google ScholarPubMed
Lutterman, T. National Association of State Mental Health Program Directors Research Institute Fiscal Year 2010 Revenues and Expenditure Study Results. 2012.Google Scholar
Lamb, HR, Weinberger, LE. Persons with severe mental illness in jails and prisons: a review. Psychiatr. Serv. 1998; 49(4): 483892.CrossRefGoogle ScholarPubMed
Baillargeon, J, Binswanger, IA, Penn, JV, Williams, BA, Murray, OJ. Psychiatric disorders and repeat incarcerations: the revolving prison door. Am. J. Psychiatry. 2009; 166(1): 103109.CrossRefGoogle ScholarPubMed
Fazel, S, Seewald, K. Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis. Br. J. Psychiatry. 2012; 200(5): 364373.CrossRefGoogle ScholarPubMed
Torrey, EF, Kennard, AD, Eslinger, D, Lamb, R, Pavle, J. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. Treatment Advocacy Center and National Sheriff’s Association; 2010. Scholar
Binder, RL, McNiel, DE. The relationship of gender to violent behavior in acutely disturbed psychiatric patients. J. Clin. Psychiatry. 1990; 51(3): 110114.Google ScholarPubMed
Tardiff, MD, Sweillam, AS. Assaultive behavior among chronic inpatients. Am. J. Psychiatry. 1982; 139(2): 212215.Google ScholarPubMed
Linhorst, DM, Scott, LP. Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients. J. Interpers. Violence. 2004; 19(8): 857874.CrossRefGoogle ScholarPubMed
California Department of State Hospitals Aggression Data. Scholar
Results from NEI Audience Survey. Neuroscience Education Institute, Audience Survey Results, Colorado Springs. 2013.Google Scholar
Penrose, LS. Mental disease and crime: outline of a comparative study of European statistics. Br. J. Med. Psychol. 1939; 18(1): 115.CrossRefGoogle Scholar
Morgan, RD, Fisher, WH, Duan, N, Mandracchia, JT, Murray, D. Prevalence of criminal thinking among state prison inmates with serious mental illness. Law Hum. Behav. 2010; 34(4): 324336.CrossRefGoogle ScholarPubMed
Appelbaum, KL, Dvoskin, JA. Consultation report on the Clifton T. Perkins Hospital Center. 2012. mha/Documents/CTPHC%20Findings%20to%20Date%201-10-12.pdf.Google Scholar
Abramson, MF. The criminalization of mentally disordered behavior: possible side effect of a new mental health law. Hosp. Community Psychiatry. 1972; 23(4): 101105.Google ScholarPubMed
Swank, GE, Winer, D. Occurrence of psychiatric disorder in a county jail population. Am. J. Psychiatry. 1976; 133(11): 13311333.Google Scholar
Sosowsky, L. Crime and violence among mental patients reconsidered in view of the new legal relationship between the state and the mentally ill. Am. J. Psychiatry. 1978; 135(1): 3342.Google ScholarPubMed
A mental health overhaul: a congressman produces a set of good ideas for a difficult problem. Wall Street Journal. December 25, 2013. Scholar
Swanson, JW, Holzer, CE 3rd, Ganju, VK, Jono, RT. Violence and psychiatric disorder in the community: evidence in the Epidemiologic Catchment Area surveys. Hosp. Community Psychiatry. 1990; 41(7): 761770.Google ScholarPubMed
Steadman, HJ, Mulvey, EP, Monahan, J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch. Gen. Psychiatry. 1998; 55(5): 393401.CrossRefGoogle ScholarPubMed
Nolan, KA, Czobor, P, Roy, BB, et al. Characteristics of assaultive behavior among psychiatric inpatients. Psychiatr. Serv. 2003; 54(7): 10121016.CrossRefGoogle ScholarPubMed
Quanbeck, CD, McDermott, BE, Lam, J, et al. Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatr. Serv. 2007; 58(4): 521528.CrossRefGoogle ScholarPubMed
Maloy, JR. Empirical basis and forensic application of affective and predatory violence. Aust. N. Z. J. Psychiatry. 2006; 40(6–7): 539547.CrossRefGoogle Scholar
McDermott, BE, Edens, JF, Quanbeck, CD, Busse, D, Scott, CL. Examining the role of static and dynamic risk factors in the prediction of inpatient violence: variable and person-focused analyses. Law Hum. Behav. 2008; 32(4): 325338.CrossRefGoogle Scholar
Harris, GT, Rice, ME. Treatment of psychopathy: a review of empirical findings. In: Patrick, CJ, ed. Handbook of Psychopathy. New York: The Guilford Press; 2005: 555572.Google Scholar
Salekin, RT. Psychopathy and therapeutic pessimism: clinical lore or clinical reality? Clin. Psychol. Rev. 2002; 22(1): 79112.CrossRefGoogle ScholarPubMed
Skeem, JL, Monahan, J, Mulvey, EP. Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients. Law Hum. Behav. 2002; 26(6): 577603.CrossRefGoogle ScholarPubMed
Douglas, KS, Hart, SD, Webster, CD, et al. HCR-20V3: Assessing Risk of Violence—User Guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 2013.Google Scholar
Hare, RD. Manual for the Revised Psychopathy Checklist, 2nd edn. Toronto: Multi-Health Systems; 2003.Google Scholar
Hart, SD, Cox, DN, Hare, RD. The Hare Psychopathy Checklist: Screening Version. Toronto: Multi-Health Systems; 1995.Google Scholar
Monahan, J, Steadman, HJ, Robbins, PC, et al. An actuarial model of violence risk assessment for persons with mental disorders. Psychiatr. Serv. 2005; 56(7): 810815.CrossRefGoogle ScholarPubMed
Webster, CD, Martin, ML, Brink, J, et al. Manual for the Short-Term Assessment of Risk and Treatability (START) (Version 1.1). Port Coquitlam, BC, Canada: Forensic Psychiatric Services Commission and St. Joseph’s Healthcare; 2009.Google Scholar
Bjørkly, S, Hartvig, P, Heggen, FA, et al. Development of a brief screen for violence risk (V-RISK-10) in acute and general psychiatry: an introduction with emphasis on findings from a naturalistic test of interrater reliability. Eur. Psychiatry. 2009; 24(6): 388394.CrossRefGoogle ScholarPubMed
Strasburger, LH, Gutheil, TG, Brodsky, A. On wearing two hats: role conflict in serving as both psychotherapist and expert witness. Am. J. Psychiatry. 1997; 154(4): 448456.Google ScholarPubMed
Greenberg, SA, Shuman, DA. Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research and Practice. 1997; 28(1): 5057.CrossRefGoogle Scholar
Kennedy, HG. Therapeutic uses of security: mapping forensic mental health services by stratifying risk. Advances in Psychiatric Treatment. 2002; 8(6): 433443.CrossRefGoogle Scholar

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