Speaker: Rosemary Purcell (Orygen Youth Health Research Centre)
Rosemary has been looking at the research evidence between mental illness and violence in a forensic youth context.
Are the rates of violence higher among those with mentall illness?
In the 1960s and 1970s there were some minor correlations, though observed associations were minimised, if not outright denied, in the literature. For political reasons some researchers “literally ignored their own findings.”
Now, these issues remain highly contentious with fear that findings might reinforce community stereotypes and stigma. The evidence shows that the overwhelming majority (99%) of people with Schizophrenia will not be violent, but there is a significant relationship between people with schizophrenia and other psychotic illnesses and violence episodes. We do a disservice to ourselves and consumers not to acknowledge this.
Prison research has found unusually large levels of schizophrenia (10%+) in inmate populations. Other research has found significant correlations between people with shizophrenia and self-reported assaultive behaviour. There are also data linkages between legal convictions and registers of public psychiatric contacts. Linkages have been found with psychotic illnesses, affective disorders and personality disorders. These relationships appear to be mediated by the level of substance misuse.
When do these assaultive episodes tend to occur?
Approximately 40%-60% of homicides by people with mental illness involve individuals experiencing their first epsiode of psychosis. There is also a highger likelihood of assualtive behaviour the longer an individual goes untreated. This suggests that early intervention would be highly effective.
Orygen Youth Health and Forensicare created a satellite clinic intended to deal with young people (15-25) experiencing signs of ‘ultra high risk’ of psychosis and violence. Primary and secondary consultations involve general risk assessments and risk management plans of OYH clients. They also focus on specialised problem behaviours (e.g. stalking).
Anthony Maden’s 10 Commandments guide OYH-FSC.
1. Violence is the business of all clinicians.
2-10 (skipped through)
After a one-year pilot the majority of clinicians who worked at this specialist clinic felt the access and support they got from the clinic was benefitial to their ability to manag risk associated with problem behaviours. Unfortunately the pilot program was defunded at the end of the first year, making the full case for the evidence hard to present.
The challenge to mental health services is that violence risk management is every clinician’s business as there simply aren’t enough forensic mental health specialists to go around.
Questions
Q1: What tools do you use?
Forensicare uses the HCR20 and the SAVRY(?). The level of risk our staff sat with was extremely high (moderate to severe).
Q2: The group the data was taken from for the evidence is 15 years old. Is the data still valid?
There don’t seem to have been many changes in services to expect the data to have changed dramatically. I gave a simple overview to demonstrate the point. There are possibly three separate groups: Young people exhibiting violent tendancies developing mental illness; people with mental illness where the violence is a part of the symptomology; and people with chronic mental illness who have a single incident.
Q3: Why are people with mental illness all lumped into this statistic?
We need to have a discussion in the community to explain the fact that 99% of people with a mental illness do not behave violently. There is that small section of the population that we have to discuss.
Q4: Where has the 99% statistic come from? Has everyone with psychosis been hospitalised? Are these myths?
Paul Mullen compiled this in his report. The media are more interested in sound bites of “psychos” perpetrating violence. (references were provided)
Q5: Why do we have a separate forensic system instead of dealing with risk in the general psychiatric system?
We seem to focus on “do no harm” to the client, but the client can also do harm to us. We have to keep talking about this. Training is a big component of it.
Q6: What is the cost of high-secure institutional care?
Unknown – Paul McCrone is about to publish some work on the cost of homicide on the mentally ill, which may give us an idea. Although why we aren’t asking what the cost is of a lost life might be a more important question.
Q7: What sort of supervision do the workers get at Orygen?
Peer supervision and a fairly good supervision system across the organisation. Both connected through Orygen and Forensicare. Low turnover also helped.
