Chapter 9 - Management of the Risk of Violence in the Community

Summary

Since the 1950s, there has been a substantial shift from long-term institutional mental health (MH) care to community-based services. The introduction of specialist community-based teams and a 70 per cent reduction in MH beds in the UK since the late 1980s means that people with greater acuity of illness and complexity are being treated in the community. As a consequence, MH services are more likely to need to manage violent behaviour in the community. Within MH services, successful management of violence is predicated on a range of factors/interventions. These include management of specific conditions, most notably schizophrenia, personality disorder and substance misuse. Multidisciplinary team working, effective communication and collaboration across services play important roles, arguably more so than the service model. Key clinical risk factors for violence in mental illness, how to modify these risks in community MH services, different service models that may help achieve this, domestic violence and lone working are discussed. Liaison with the police, the role of AMHPs, MHA assessments, and law and guidance on personal safety in the community are also discussed. The criminal justice system has an important role in addressing violence, and there is mention also of the Code for Crown Prosecutors and MAPPA arrangements.