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Implementation of a specialized program to treat violence in a forensic population

Published online by Cambridge University Press:  11 March 2020

Susan Velasquez Open the ORCID record for Susan Velasquez [Opens in a new window] ,
Andrea Bauchowitz ,
David Pyo  and
Megan Pollock
Susan Velasquez*
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Andrea Bauchowitz
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
David Pyo
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Megan Pollock
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
*
*Address for correspondence: S. Velasquez, PhD, Department of State Hospitals-Clinical Operations, 1600 9th Street Suite 400, Sacramento, CA 95814, USA. (Email: [email protected])
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Abstract

A shift within state psychiatric hospitals toward serving a predominantly forensic population has resulted in increased violent incidents within those settings. Thus, addressing criminogenic needs in addition to mental illness is an important paradigm shift. Relying on seclusion or restraint as the primary mechanisms to address violence interferes with the provision of effective care to patients struggling with aggressive behaviors. Implementing new treatment programs aimed at reducing violence in forensic inpatient settings is warranted. This article focuses on the step-by-step process of developing such a specialized treatment program within the California Department of State Hospitals. Leadership within this hospital system collaborated with labor unions and other stakeholders to obtain funding to create a novel treatment environment. This treatment program includes a ward design aimed to improve safety and delivers treatment based on the Risk Needs Responsivity Model. Treatment is guided by violence risk assessment and primarily focused on addressing criminogenic needs. The selection of treatments with a focus on violence reduction is discussed.

Keywords

Violencetreatmentforensic
Type
Perspectives
Information
CNS Spectrums , Volume 25 , Issue 5 , October 2020 , pp. 571 - 576
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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Footnotes

The findings and conclusions in “Implementation of a specialized program to treat violence in a forensic population” are those of the author(s) and do not necessarily represent the views or opinions of the Department of State Hospitals or the California Health and Human Services Agency.

References

References:

Warburton, K. The new mission of forensic mental health systems: managing violence as a medical syndrome in an environment that balances treatment and safety. CNS Spectr. 2014;19:368–373. https://doi.org/10.1017/S109285291400025X.CrossRefGoogle Scholar
Fisher, W, Geller, JL, Pandiani, JA. The changing role of the state psychiatric hospital. Health Affairs. 2009;28(3):676–684. https://doi.org/10.1377/hlthaff.28.3.676.CrossRefGoogle ScholarPubMed
Bader, S, Evans, SE, Welsh, E. Aggression among psychiatric inpatients: the relationship between time, place, victims, and severity ratings. J Am Psychiatr Nurses Assoc. 2014;20(3):179–186. https://doi.org/10.1177/1078390314537377.CrossRefGoogle ScholarPubMed
Broderick, C. Violence Report: DSH Violence 2010–2017: California Department of State Hospitals, 2019:265.Google Scholar
Morgan, R, Flora, DB, Kroner, DG, Mills, JF, Varghese, F, Steffan, JS. Treating offenders with mental illness: a research synthesis. Law Hum Behav. 2012;36(1):37–50. https://doi.org/10.1037/h0093964.CrossRefGoogle ScholarPubMed
Andrews, D. The risk-need-responsivity (RNR) model of correctional assessment and treatment. In: Dvoskin, J, Skeem, JL, Novaco, RW, Douglas, KS, eds. Using Social Science to Reduce Violent Offending. New York, NY: Oxford University Press; 2012.Google Scholar
Skeem, J, Steadman, HJ, Manchak, SM Applicability of the risk-need-responsivity model to persons with mental illness involved in the criminal justice system. Psychiatr Serv. 2015;66:916–922. https://doi.org/10.1176/appi.ps.201400448.CrossRefGoogle ScholarPubMed
Delgado, D, Mitchell, S, Morgan, R, Scanlon, F. Examining violence among not guilty by reason of insanity state hospital inpatients across multiple timepoints: the roles of criminogenic risk factors and psychiatric symptoms. Manuscript submitted for publication; 2019CrossRefGoogle Scholar
Andrews, D, Bonta, J, Hoge, RD. Classification for effective rehabilitation: rediscovering psychology. Crim Justice Behav. 1990;17(1):19–52. https://doi.org/10.1177/0093854890017001004.CrossRefGoogle Scholar
Sugarman, P, Dickens, G. The Evolution of Secure and Forensic Mental Healthcare. England, UK: RCPsych Publications; 2015.Google Scholar
Ulrich, R, Bogren, L, Gardiner, SK, Lundin, S. Psychiatric ward design can reduce aggressive behavior. J Environ Psychol. 2018;57:53–66. https://doi.org/10.1016/j.jenvp.2018.05.002.Google Scholar
Glynn, S, Mueser, KT. Social learning for chronic mental inpatients. Schizophr Bull. 1986;12(4):648–668.CrossRefGoogle ScholarPubMed
Douglas, K, Nicholls, TL, Brink, J. Interventions for the Reduction of Violence by Persons with Serious Mental Illness; 2016.Google Scholar
Paul, G, Lentz, R. Psychosocial Treatment of Chronic Mental Patients: Milieu versus Social-Learning Programs. Cambridge, MA: Harvard University Press; 1977.Google Scholar
Crichton, J. Defining high, medium, and low security in forensic mental healthcare: the development of the matric of security in Scotland. J Forens Psychiatry Psychol. 2009;20(3):333–353. https://doi.org/10.1080/14789940802542808.CrossRefGoogle Scholar
Achadjian, K. Enhanced Treatment Programs. AB-1340; 2014.Google Scholar
Douglas, K, Skeem, JL Violence risk assessment: getting specific about being dynamic. Psychol Public Policy Law. 2005;11(3):347–383. https://doi.org/10.1037/1076-8971.11.3.347.CrossRefGoogle Scholar
Dvoskin, J, Heilbrun, K. Risk assessment and release decision-making: toward resolving the great debate. J Am Acad Psychiatry Law. 2001;29:6–10.Google ScholarPubMed
Kraemer, H, Kazdin, AE, Offord, DR, Kessler, RC, Jensen, PS, Kupfer, DJ Coming to terms with the terms of risk. Archiv Gen Psychiatry. 1997;54:337–343. https://doi.org/10.1001/archpsyc.1997.01830160065009.CrossRefGoogle ScholarPubMed
De Vries Robbe, M, De Vogel, V, Douglas, KS, Nijman, HLI. Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: predicting reductions in post discharge community recidivism. Law Hum Behav. 2015;39(1):53–56. https://doi.org/10.1037/lhb0000089.CrossRefGoogle Scholar
Quanbeck, C. Forensic psychiatric aspects of inpatient violence. Psychiatr Clin N Am. 2006;29:743–760. https://doi.org/10.1016/j.psc.2006.04.011.CrossRefGoogle ScholarPubMed
Stahl, S, Morrissette, DA, Cummings, M, et al. California State Hospital Assessment and Treatment (Cal-VAT) guidelines. CNS Spectr. 2014;19:4490465. https://doi.org/10.1017/s1092852914000376.CrossRefGoogle ScholarPubMed
Douglas, K, Hart, SD, Webster, CD, Belfrage, H. HCR-20V3: Professional Guidelines for Evaluating Risk of Violence. Mental Health, Law, and Policy ed. Burnaby, Canada: Simon Fraser University Press; 2013.Google Scholar
Webster, C, Nicholls, TL, Martin, ML, Desmarais, SL, Brink, J. Short-Term Assessment of Risk and Treatability (START): the case for a new violence risk structured professional judgment scheme. Behav Sci Law. 2006;24:757–766. https://doi.org/10.1002/bsl.737.CrossRefGoogle ScholarPubMed
Hare, R. The Hare Psychopathy Checklist-Revised. (2nd ed.) Toronto, Canada: Multi-Health Systems; 2003.Google Scholar
Penney, S, Marshall, LA, Simpson, AIF The assessment of dynamic risk among forensic psychiatric patients transitioning to the community. Law Hum Behav. 2016;40:374–386. https://doi.org/10.1037/lhb0000183.Google ScholarPubMed
Hogan, N, Olver, ME Assessing risk for aggression in forensic psychiatric inpatients: an examination of five measures. Law Hum Behav. 2016;40(3):233–243. https://doi.org/10.1037/lhb0000179.CrossRefGoogle ScholarPubMed
Hogan, N, Olver, ME Static and dynamic assessment of violence risk among discharged forensic patients. Crim Just Behav. 2019;47(7):923–938. https://doi.org/10.11770093854819846586.CrossRefGoogle Scholar
Watt, K, Storey, JE, Hart, D. Violence risk identification, assessment and management practices in inpatient psychiatry. J Threat Assess Manag. 2018;5(3):155–172. https://doi.org/10.1037/tam0000099.CrossRefGoogle Scholar
Greenberg, S, Shuman, DA. Irreconcilable conflict between therapeutic and forensic roles. Profess Psychol Res Pract. 1997;28(1):50–57.CrossRefGoogle Scholar
Douglas, K, Nicholls, TL, Brink, J. Reducing the risk of violence among people with serious mental illness: a critical analysis of treatment approaches. In: Kleespies, P, ed. Behavioral Emergencies: An Evidence-Based Resource for Evaluating and Managing Risk of Suicide, Violence, and Victimization. Washington, DC: American Psychological Association; 2009.Google Scholar
Viljoen, J, Cochrane, DM, Jonnson, MR Do risk assessment tools help manage and reduce risk of violence and reoffending? A systematic review. Law Hum Behav. 2018;42(3):181–214. https://doi.org/10.1037/lhb00000280.CrossRefGoogle ScholarPubMed
Morgan, R, Kroner, DG, Mills, JF. A Treatment Manual for Justice Involved Persons with Mental Illness. New York, NY: Routledge; 2018.Google Scholar
Kingdon, D, Turkington, D. Cognitive Therapy of Schizophrenia. New York, NY: Guilford Press; 2005.Google Scholar
Linehan, M. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press; 1993.Google Scholar
Roberts, D, Penn, D, Combs, D. Social Cognition and Interaction Training (SCIT). New York, NY: Oxford University Press; 2016.Google Scholar
Shah, T, Weinborn, M, Verdile, G, Sohrabi, H, Martins, R. Enhancing cognitive functioning in healthy older adults: a systematic review of the clinical significance of commercially available computerized cognitive training in preventing cognitive decline. Neuropsychol Rev. 2017;27(1):62–80. https://doi.org/10.1007/s11065-016-9338-9.Google ScholarPubMed
Morgan, R, Kroner, DG, Mills, JF, Bauer, R, Serna, C. Treating justice involved persons with mental illness: preliminary evaluation of a comprehensive treatment program. Crim Just Behav. 2014;41:902–916. https://doi.org/10.1177/0093854813508553.CrossRefGoogle Scholar
Frazier, S, Vela, J. Dialectical behavior therapy for the treatment of anger and aggressive behaviors: a review. Aggress Violent Behav. 2014;19(2):156–163. https://doi.org/10.1016/j.avb.2014.02.001.Google Scholar
Haddock, G, Barrowclough, C, Shaw, JJ, Dunn, G, Novaco, RW, Tarrier, N. Cognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. Br J Psychiatry. 2009;194:152–157. https://doi.org/10.1192/bjp.bp.107.039859.CrossRefGoogle Scholar
O'Reilly, K, Donohoe, G, O'Sullivan, D, et al. A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder. BMC Psychiatry. 2019;19:27. https://doi.org/10.1186/s12888-019-2018-6.CrossRefGoogle ScholarPubMed
Kern, R, Glynn, SM, Horan, WP, Marder, SR. Psychosocial treatments to promote functional recovery in schizophrenia. Schizophr Bull. 2009;35(2):347–367.Google Scholar
Bellack, A, Mueser, KT, Gingerich, S, Agresta, J. Social Skills Training for Schizophrenia: A Step-by-Step Guide. New York, NY: The Guilldord Press; 2004.Google Scholar
Miller, W, Rollnick, S. Motivational Interviewing: Helping People Change. (3rd ed.) New York, NY: Guilford Press; 2013.Google Scholar
Ginsburg, J, Mann, RE, Rotgers, F, Weekes, JR. Motivational interviewing with criminal justice populations. In: Miller, W, Rollnick, SR, ed. Motivational Interviewing: Preparing People for Change. New York, NY: Guilford Press; 2002.Google Scholar
Barlett, M, Desteno, D. Gratitude and prosocial behavior: helping when it costs you. Assoc Psychol Sci. 2006;17(4):319–324. https://doi.org/10.1111/j.1467-9280.2006.01705.x.CrossRefGoogle Scholar
Swanson, J, Van Dorn, RA, Swartz, MS, Smith, A, Elbogen, EB, Monahan, J. Alternative pathways to violence in persons with schizophrenia: the role of childhood antisocial behavior problems. Law Hum Behav. 2008;32:228–240. https://doi.org/10.1007/s10979-007-9095-7.Google ScholarPubMed