Violence Risk Assessment and Serial Homicide Evaluation

Introduction: Mental Illness and Violence

The objective of this study is to examine violence risk assessment and the types of tools available, along with their effectiveness for identifying likely violent reoffenders. Lurigio and Harris (2009) report in their work "Mental Illness, Violence, and Risk Assessment: An Evidence-Based Review" that the presumed link "between violence and mental illness has long been an ongoing subject of investigation." A central question is whether those who are mentally ill are more likely "than those without mental illness to commit violent crimes" (Lurigio and Harris, 2009). A related question is whether mental health and criminal justice professionals can accurately assess the likelihood of violence (Lurigio and Harris, 2009).

It is reported that mentally ill individuals diagnosed with conditions including schizophrenia, major depression, and bipolar disorder have historically been shunned, "in part because of the stereotype that they are dangerous" (Lurigio and Harris, 2009). Over the past twenty years, a number of epidemiological studies have examined the relationship between mental illness and violence. Swanson (1994) found that individuals with mental illness were "more than twice as likely to be involved in assaultive acts as people with no such illness. However, the study found that this difference could be explained mostly by the presence of co-occurring substance use disorders" (Lurigio and Harris, 2009).

Co-Occurring Mental Illness and Substance Use Disorders

The findings state specifically that individuals with "substance use disorders were more than twice as likely to be involved in assaultive acts as people with only mental illness, and those with both mental illness and substance use disorders were the most likely group to be involved in assaultive acts" (Lurigio and Harris, 2009). Study findings further demonstrated that severe mental illness alone "was unrelated to violence. However, people with co-occurring mental illness and substance use disorders were more likely to report violent acts than people with substance use disorders alone" (Lurigio and Harris, 2009).

Also increasing the risk of violence among individuals with mental illness were contextual, clinical, and historical factors. In yet another study, findings indicate that individuals with mental illness and no other risk factors for violence "were no more likely to engage in assaultive acts than members of the general population" (Lurigio and Harris, 2009). A similar study found that "symptoms such as paranoid delusions and command hallucinations—and not diagnoses per se—predicted violence among people with mental illness" (Lurigio and Harris, 2009).

Legal History of Dangerousness Prediction

Monahan and Steadman (2006) in "Violence Risk Assessment: A Quarter Century of Research" cite the earlier observation of Halleck (1967) in "Psychiatry and the Dilemmas of Crime":

"Research in the area of dangerous behavior (other than generalizations from case materials) is practically nonexistent. Predictive studies which have examined the probability of recidivism have not focused on the issue of dangerousness. If the psychiatrist or any other behavioral scientist were asked to show proof of his predictive skills, objective data could not be offered." (Monahan and Steadman, 2006)

The concept of dangerousness was introduced into civil commitment statutes as the sole basis for commitment in 1972, defining dangerousness as "a high probability of inflicting imminent substantial physical harm based on a recent explicit act" (Monahan and Steadman, 2006). However, in 1974, the American Psychiatric Association concluded that "psychiatric expertise in the prediction of 'dangerousness' is not established and clinicians should avoid 'conclusory' judgments in this regard" (Monahan and Steadman, 2006).

Thomas Barefoot was convicted of the capital murder of a police officer in 1978. At his sentencing hearing, the jury considered whether the conduct that caused the death of the deceased "was committed deliberately and with reasonable expectation that the death of the deceased or another would result," and whether "there is a probability that the defendant would commit criminal acts of violence that would constitute a continuing threat to society" (Monahan and Steadman, 2006). The jury answered affirmatively to both questions, requiring that the death penalty be imposed. When the case reached the Supreme Court on the constitutionality of clinical predictions of violence as a basis for execution, Justice White argued that in Jurek, "seven Justices rejected the claim that it was impossible to predict future behavior and that dangerousness was therefore an invalid consideration in imposing the death penalty" (Monahan and Steadman, 2006).

In a case that followed in 1984, the U.S. Supreme Court stated that "despite research showing low accuracy rates, as a matter of law clinical risk prediction is an acceptable means of assessing dangerousness" (Monahan and Steadman, 2006). This decision established the status quo that has governed the U.S. judicial system to the present day. The American Psychiatric Association's (1983) model state law on civil commitment "included the involuntary hospitalization of people with mental disorders who are 'likely to cause harm to others.'" The guidelines from the National Center for State Courts (1986) stated that "close attention…should be paid to predictions of future behavior, especially predictions of violence and assessments of dangerousness" (Monahan and Steadman, 2006).

Complicating the situation is the clinician who acknowledges "limited competence to offer estimates of the future" and yet is legally mandated to do precisely that. The professional consensus is reported to be "that predictions of future dangerousness will remain a significant element in legal decisions to restrict the liberty of individuals with mental disorders" (Monahan and Steadman, 2006).

Constitutional challenges to risk assessment have been rejected by the Supreme Court. The legal questions posed by violence prediction are framed primarily in tort law. Tarasoff v. Regents of the University of California (1976) is the landmark case in this area, in which the California Supreme Court held that "psychotherapists who know or should know of their patient's likelihood to inflict injury on identifiable third parties have an obligation to take reasonable steps to protect the potential victim" (Monahan and Steadman, 2006). Only a few state courts have rejected this ruling, while other states have limited its scope; the majority of courts have "accepted the essence of the 'duty to protect,' and several have even expanded that duty to include nonidentifiable victims" (Monahan and Steadman, 2006). A legal issue that remains unresolved involves "the development of professional standards for institutionalizing a potentially violent person or releasing that person from an institution. Liability, rather than constitutionality, is the concern that motivates interest in the accurate prediction of violence in the mid-1990s" (Monahan and Steadman, 2006).

References

DeFronzo, J., and Prochnow, J. (2004). Violent cultural factors and serial homicide by males. Psychological Reports, 94(1), 104–108.

Knoll, J. (2006). Serial murder: A forensic psychiatric perspective. Psychiatric Times, March 2006.

Lurigio, A. J., and Harris, A. J. (2009). Mental illness, violence, and risk assessment: An evidence-based review. Victims and Offenders, 4, 341–347. Taylor & Francis Group.

Monahan, J., and Steadman, H. J. (2006). Violence risk assessment: A quarter century of research.

Sreenivasan, S., et al. (2000). Actuarial risk assessment models: A review of critical issues related to violence and sex-offender recidivism assessments. The Journal of the American Academy of Psychiatry and the Law, 28, 438–448.