E-Book Overview
The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work.
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RETHINKING RISK ASSESSMENT This page intentionally left blank Rethinking Risk Assessment The MacArthur Study of Mental Disorder and Violence by JOHN MONAHAN HENRY J. STEADMAN ERIC SILVER PAUL S. APPELBAUM PAMELA CLARK ROBBINS EDWARD P. MULVEY LOREN H. ROTH THOMAS GRISSO STEVEN BANKS OXTORD UNIVERSITY PRESS 2001 OXPORD UNIVERSITY PRESS Oxford New York Athens Auckland Bangkok Bogota Buenos Aires Calcutta Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris Sao Paulo Shanghai Singapore Taipei Tokyo Toronto Warsaw and associated companies in Berlin Ibadan Copyright © 2001 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 http://www.oup-usa.org All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Rethinking risk assessment: the MacArthur study of mental disorder and violence / by John Monahan . . . [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 0-19-513882-1 1. MacArthur Violence Risk Assessment Study. 2. Dangerously mentally ill—United States. 3. Violence—United States. 4. Risk assessment—United States. 5. Insane—Commitment and Detention—United States. I. Monahan, John, 1946- II. MacArthur Violence Risk Assessment Study. [DNLM: 1. Mental Disorders—diagnosis. 2. Violence—psychology. 3. Mental Disorders—psychology. 4. Risk Assessment—methods. 5. Risk Factors. WM 141 R438 2000] RC569.5.V55 R47 2000 616.89'075-dc21 00-062434 98765 Printed in the United States of America on acid-free paper PREFACE Despite enormous advances in the diagnosis and treatment of mental disorder in recent decades, the social stigma associated with having a mental disorder remains great. Why is this so? According to the Surgeon General's first Report on Mental Health (1999), "The answer appears to be fear of violence: people with mental illness, especially those with psychosis, are perceived to be more violent than in the past" (p. 7). This perception has become a driving force — often the driving force — in mental health law and policy in the United States and throughout the world. This book addresses the violence that people with mental disorder