Despite a constant increase in a quantity of different drugs, assessment tools, diagnostic means, progress in prevention and treatment and advances in medicine, mental disorders are a serious and frequently encountered clinical issue. They interfere with most aspects of humans’ well-being, affect the way people think, function and behave; they can disable an individual and impair health. Moreover, major mental illnesses are associated with aggression and violent behavior.
According to its clearly identified objective, the article “Interventions to address violence associated with mental illness” published in the Australian Psychiatry Journal in 2008 is designed “to consider the association between mental illness and violence, and discuss broad intervention approaches” (Scott, 405). The background to this study, problem statement, purpose, and its significance identify crucial aspects of this issue. The research outlined solutions to the treatment of patients with psychotic disorders by examining the factors that contribute to the disease, reviewed the array of interventions already undertaken and made recommendations for further actions.
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Russ Scott, an Australian forensic psychiatrist, determines holistic care, access to mental health services, and official regulations as indispensable elements of interventions to reduce rates of assaults and violence associated with mental disorders. The author explores and evaluates the existing evidence for interconnections between mental illnesses and violence, identifies the most significant “mediators and confounders in the relationship between mental illness and violence”, and estimates “the implications for service delivery” (Scott, 2008, p. 405).
The following key words were used in the article to clarify the main aspects of the research: community mental health, prison mental health, violence.
The publication “Interventions to address violence associated with mental illness” can be defined as a reliable source of information due to its solid theoretical underpinnings. The significance of the study is substantiated through in-depth analyses of the official documents and data; the research process entailed the review of 50 sources including peer review journals, online publications, and scholarly research from reputable international and national (Australian and New Zealand, British, and American) healthcare organizations, which were used to obtain relevant information and accurate data. The scientist analyzed previously published studies on specific characteristics of offenders, prisoners, and psychiatric inpatients, mental illnesses, their epidemiology, assessment, and treatment, correlations between violent behavior and psychotic disorders, and types of mental health services. All the sources were evaluated and utilized in accordance with their timeliness, quality of methodology, relevance, and importance of results. The author’s statements and recommendations are supplied with pertinent references. The article provides the target audience of readers with evidence-based sources published during 7 years (2000 – 2007).
The article “Interventions to address violence associated with mental illness” includes a vast array of statistical data and numerical specifications concerning “the average length of stay for all mental health-related separations for admitted patient care” (p. 407), attributable risks of victim injuries, bed numbers (p. 406), and needs for “state and territory funded places per 100 000 head of population” (p. 408). Providing numerical data, the author promotes a deeper insight into the implications that this research paper has for the decrease in assaults and violence associated with mental illnesses.
Scott identifies hazardous drinking, alcohol and other types of substance abuse, social disadvantage, adversity, poverty, “problems with employment, and a paucity of pro-social attachments” as factors contributing to an increase in violence in patients with mental disorders (p. 406).
Comparing rates of crimes, patients’ morbidity and mortality, and mental health needs, the publication is focused on similarities and differences in specific interventions to reduce violence designed for custodial settings and community settings. Such innovative services and interventions as “screening, early intervention and treatment in prison and assertive post-release case management to divert mentally ill offenders away from” hazardous drinking, alcohol dependence, and drug abuse should be utilized in custodial settings (Scott, 2008, p. 407). Interventions and services in community settings should be based on active case management, which involves “access to inpatient beds and co-ordination between mental health services and other agencies” (p. 405). In addition, Scott emphasizes the significance of comprehensive discharge planning, control of substance and alcohol use, “competent care, access to services, and legal leverage” (p. 408).
Although freely given informed consent is obligatory to medical research or other practice involving human participants, persons with psychotic disorders frequently avoid or refuse to accept treatment due to their specific characteristics and limited insight into their mental conditions. Therefore, in order to reduce violence associated with mental illnesses, such individuals should be provided with involuntary treatment in accordance with legal leverage. Australian official regulations of involuntary treatment include the following options: “involuntary treatment orders, forensic orders, conditions of probation or parole or court-ordered diversion of offenders with substance use disorders” (Scott, 2008, p. 408).
Taking into consideration the increasing complexity of health care delivery to patients with a history of assaultive behavior, Scott strongly recommends utilizing an interdisciplinary team approach to medical aid provision. An interdisciplinary team involves medical personnel of different disciplines in order to provide a deliberate, well-supported, comprehensive, and appropriate treatment. The main objective of the interdisciplinary team approach is to improve the treatment quality by integrating various data and information obtained from different health care disciplines. Such mental health services could operate “by an integrated model, a parallel model, or a hybrid of both models, depending on a range of factors including demography and the availability of resources and personnel” (Scott, 2008, p. 409). In order to prevent assaultive actions of patients with mental illnesses, interdisciplinary teams should liaise with forensic services, correctional and other agencies.
The author summarized the findings in the final part of the publication. According to Scott, it is essential to ensure that everybody “identified with a major mental illness” (p. 409) is provided with the most appropriate assessment tools and deliberate active interventions in order to reduce violence. Scott focuses on the importance of wide interpretations of criteria for supervision and treatment defined by legal leverage. Based on the study data and the author’s propositions, new models of psychotic disorders care can be designed and implemented in custodial and community settings.
To conclude, all publications on health care issues should be evaluated in conformity with their evidence-based orientation, efficiency, and expediency of proposed methods. The article “Interventions to address violence associated with mental illness” is a valuable source of information for those involved in treatment and supervision of patients with mental illnesses. Thus, in order to reduce violence associated with psychotic disorders empowered policymakers, health care providers, social labour workers, and administrators of custodial and community settings should be aware of the intervention approaches promulgated in the publication.
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