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    Posted May 24, 2014 by
    drkathy2
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    Violence Risk Reduction Plans

     

    Whether a person’s problems are behavioral, mental health, substance abuse, or legal, those that have the most complex array of violence risk factors and the least effective coping skills, are most likely to commit violence when under severe stress and need a risk reduction plan. It is not really rocket science to make a list of commonly agreed upon violence risk factors and screen folks with serious problems for those risk factors. A recent 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 raises at least 2 issues:
    • Why isn’t everyone using a validated violence risk assessment 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 Plan must be applied. The research on these 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 is now in a mental hospital. It is assumed he will be in the hospital until he is no longer a danger to himself or others. How do people know when that is? They cannot be sure unless they use a valid risk reduction plan.

     

    On May 21, 2014, police arrested Carol Coronado on suspicion of stabbing her 3 young daughters to death at their home in Los Angeles County. Carol allegedly called her mother and said she thought she was going crazy. The children’s grandmother rushed to the house and discovered them lying on a bed with their mother. The 3 small girls were already dead. Did anyone know that this woman was struggling and did they know what to do to help her?  Was she seeing a therapist or doctor?  Did she have a violence risk reduction plan?

     

    Peter Rodger, assistant director of the Hunger Games, 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 was seeing a psychiatrist.  Did ge have a violence risk reduction plan?  He is now dead along with 6 victims, so we do not have to worry about the risk of recidivism when he gets out of jail or a hosptal. However, I am sure there are other youth out there that are just as disturbed as this young man and as much at risk for violence. They need to be found and violence risk reduction plans put into place before murders take place. I am not talking about incarceration. I am talking about risk reduction treatment plans for very disturbed people.

     

    Violence Risk Reduction Planning
    There are 2 groups of (mostly, but not always) young men (15-40) at risk for violence, youth that are mentally Ill or on the autism spectrum or youth with anti-social traits that have been chronically violent since childhood. The risk factors and violence risk reduction plans are different for those 2 groups.

     

    The mentally ill group (Erupters) are narcissistic, socially awkward, very intelligent, lacking in social support, paranoid, exhibiting signs of a personality disorder, not actively engaged in treatment, having school, home or work difficulties, having problems getting along with others, exhibiting poor anger management, may be abusing substances, showing low frustration tolerance, having a history of past emotional outbursts, or mood disorder or autism spectrum disorders. The more of these risk factors that a person has, the more likely it is that the person should receive risk reduction plans and interventions to include: family therapy, skill building, high intensity services, support, coaching, and help in a troubling environment, mental health treatment, positive activities and positive social interactions.  This can be done long before murder occurs.

     

    The chronically violent group may have a history of childhood trauma, past violence, being a bully (or has been bullied), having difficulty in school or work, deviant peers, in trouble with the law, inappropriate disciplinary practices by parents, paranoia, mental illness, substance abuse, impulsivity, delinquent or criminal behavior, lack of remorse, anger management problems, poor problem solving, being either very glib and slick or very poor social skills, neurological impairment, not compliance with treatment, a recent stressful event, lacking adequate support, frequent absences from school or work, violence, criminality, or insufficiently treated substance abuse, or mental illness in family of origin. Again the more of these risk factors a person has, the more likely that a violence risk reduction plan and 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 and treatment for all family members, mental health screening and treatment for all family members.

     

    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. Changing our approach from aftermath investigation to preventin will take a paradigm shift, not necessarily huge amounts of new money to stem the tide of US violence. Community treatment is much more effective and cost effective than no treatment in prison to end up with a 60-80% recidivism rate. The leadership of our government needs to support greater access to high quality behavioral health services in our communities and violence risk reduction plans.

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