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Finding Factors That Aid In Determining Violence After Release of Psychiatric Patients

When releasing a violent psychiatric patient from a psychiatric hospital or facility, it is crucial to think about whether the patient will hurt someone once they are released. A paper published in PLoS One states that the standard tools used to determine the patient’s risk of violence isn’t entirely accurate for preventing violence.

A set of methods used to assess these risks is called Structured Professional Judgment (SPJ). SPJ is supposed to fill the gap between the psychiatrists’ opinion and correlations between patient violence and histories. Correlations aid in making personalized predictions about each patient’s level of risk. One method, called Historical Clinical Risk Management 20, is a 20-question survey that takes into account factors such as the patient’s history of violence, substance abuse, employment, etc. Another method is called Structured Assessment of Protective Factors (SAPROF), which is similar to Historical Clinical Risk Management 20.

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Jeremy Coid and his colleagues, the authors of the paper published in PLoS One, argue that SPJ does not accurately predict if the patient will be violent and that SPJ uses a wide range of variables instead of using a narrower set of variables that can more accurately approximate the causes underlying an act of violence. Jeremy Coid and the other researchers tracked 409 patients who were in National Health Service psychiatric hospitals in England and Wales after engaging in violent and criminal behavior. The Historical Clinical Risk Management 20 and SAPROF were administered to the patients initially, another survey was given at time of release, then six months later, and again after one year. Researchers tried to identify violent acts the former patients may have committed. The research team argues that the most useful results were when they searched for links between Historical Clinical Risk Management 20, SAPROF, and violence surveys taken around the same time. Some factors to determine risk of violence were associated with a two to three-fold increase such as poor self-control, instability, difficulty coping with stress, and violent thoughts. Self-control, on the other hand, was associated with an 80% reduction. Factors that had no effect in determining risk of violence were poor living situations, inadequate support systems, and poor treatment responses, except when coupled with violent thoughts. The team suggests that keeping targeting the symptoms of psychosis and keeping patients' mental health stable is probably the most useful ways to prevent violence.


Charmaine Santos is a sophomore at the University of San Francisco pursuing a Bachelors of Science in Biology as well as minors in Chemistry and Health Studies. She volunteers alongside UCSF medical students at a student-run homeless clinic in San Francisco and is also an active volunteer with Operation Access. Charmaine is also a Social Media Assistant at Cancer InCytes Magazine.



Collins, Nathan. (2015, November 17). “Preventing (Versus Predicting) Violence After Release.” The Miller-McCune Center for Research. Retrieved December 6, 2015 from

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