Date: Fri Jan 13 00:10:39 -0800 1995
Subject: promised abstact
Reply-To: Ronald Shlensky <3004rs@rain.org>
Sender: forensic-psychiatry-request@mailbase.ac.uk
 
Promised summary of Jan 7th Science News article:Law and Disorders  by 
Bruce Bower.
 
Essentially, the article discusses recent and anticipated studies regarding
1.The idea that decision making judgment or competence of people with 
mental disorders are impaired
2. Subtleties of coercion into treatment
3. Whether people with mental disorders are more likely to be violent 
than controls
A landmark research project  due to be completed in 1996 promises to make 
significant inroads into understanding the decision-making competence of 
people with mental disorders,  the ways in which they get coerced into 
treatment  and their potential for violence. The project is funded by the 
MacArthur Foundation Research Network and preliminary findings suggest 
such things as : Mental illness often coexists with competent decision 
making and systematic screening for this in psychiatric settings rarely 
takes place. Appelbaum and Grisso are now testing a brief, standardized 
competence interview which they hope clinicians will find useful. Thus 
far 50 % of hospitalized Schizophrenics and 75% of hospitalized 
Depressives test well for competence.
Re: coercion to be hospitalized, the overall finding is that many fewer 
feel that way if participation in the admission decision process is 
facilitated. If findings thus far hold up, the suggestion is that 
treating prospective patients with respect, concern, and being certain 
they feel listened to will lessen feelings of coercion and foster 
cooperation in treatment.
Re potential for violence: This seems to be slightly greater in those 
diagnosed with mental disorders Vs controls. Mentally ill people may 
commit 2-3 times as many violent acts during their lives as those without 
psychiatric disorder. Concomitant substance abuse elevates this contrast 
radically. This is much more so in the mentally ill but also elevated in 
the non mentally ill. 
A trio of psychiatric symptoms has been found to elevate the possibility 
of violence significantly:1) frequent feelings in the past year that one 
is being dominated by forces beyond one's control. 2)the idea that 
thoughts are being put into one's head. 3) the idea that one has been 
targeted for harm by others.
The researchers hope to find a set of predictors to help clinicians 
improve their assessment of risk for violence before releasing certain 
patients into the community.
 
Abstracted or summarized by Ronald Shlensky, M.D.,J.D.