Violent behavior preceding hospitalization among persons with severe mental illness

The need to better understand and manage risk of violent behavior among per sons with severe mental illness (SMI) in community care is increasingly bei ng recognized. Of particular concern is a subset of the SMI population char acterized by a "revolving door" pattern of institutional recidivism and poo r adherence to outpatient treatment Little empirical research exists which examines the specific dimensions of violent incidents and their surrounding context in this population. The present paper describes characteristics of violent behavioral events in a sample of 331 people with psychotic or majo r mood disorders who were placed on involuntary outpatient commitment in No rth Carolina. By pooling baseline data from respondents' self-report, colla teral informant interviews, and hospital records, the study found violent b ehavior to be a problem affecting over half the sample in a 4-month period preceding hospitalization. The study also found considerable variability in the frequency of violent events, severity weapon use, subjective state whe n incidents occurred initiation of fights, settings, relationship to others involved, and associated threat of victimization. Multivariable analyses s howed that cooccurring substance abuse problems, history of criminal victim ization, and age (being younger) were significantly associated with violent behavior when all sources of data were taken into account. Clinical diagno sis and symptom variables were not related to violence in this sample. Impl ications of these findings for service delivery priorities and future resea rch are discussed.