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Treatment engagement and violence risk in mental disorders

Duke University Medical Center, Durham, North Carolina

JOHN MONAHAN, PhD

University of Virginia, Charlottesville, Virginia, USA

Correspondence: Dr Eric Elbogen, Duke University Medical Center, DUMC 3071, Durham, NC 27710, USA. Tel: +1 919 682 8394; email: eric.elbogen{at}duke.edu

Declaration of interest None. Funding detailed in Acknowledgements.

Background Research has uncovered many characteristics related to violence committed by people with mentalillness. However, relatively few studies have focused on understanding the connection between violence and dynamic, malleable variables such as a patient’s level of treatment engagement.

Aims To explore the link between community violence and patients’beliefs about psychiatric treatment benefit.

Method A sample of 1011 adults receiving out-patienttreatment for a psychiatric disorder in the public mental health systems of five US states were interviewed.

Results Bivariate analyses revealed community violence was inversely related to treatment adherence, perceived treatment need and perceived treatment effectiveness. Multivariate analyses showed these three variables were associated with reduced odds of violent and other aggressive acts.

Conclusions The results suggest clinical consideration of patients’ perceptions of treatment benefit can help enhance violence risk assessment in psychiatric practice settings.

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