Violence and mental disorder: a critical aid to the assessment and management of risk. By Stephen Blumenthal and Tony Lavender. The Zito Trust, 16 Castle Street, Hay-on-Wye, Hereford HR3 5DF, March 2000, ISBN 1-900252-11-2

✍ Scribed by Elizabeth Walsh

• Publisher: John Wiley and Sons
• Year: 2001
• Tongue: English
• Weight: 43 KB
• Volume: 11
• Category: Article
• ISSN: 0957-9664
• DOI: 10.1002/cbm.446

✦ Synopsis

John Monahan's foreword to this book says it all. He describes it as 'the most comprehensive, up-to-date, readable, and balanced assessment of the huge research and clinical literatures of violence risk assessment of which I am aware. Sponsored by the Zito trust, this excellent book is appropriate for a very broad audience by virtue of its structure and content. Divided into seven sections, for ease of use, readers are initially invited to read summarised bulleted highlights and then to read on if that section interests them.

For clinicians, it provides a reasonably brief yet remarkably comprehensive guide to the whole area of violence and mental disorder. It addresses at length the challenge of making empirical research relevant to clinical practice and attempts to persuade clinicians of the need to combine actuarial with clinical methods of risk assessment. For the academic reader, it not only succinctly combines the results of all influential work (both published and in press) but offers interesting and original insights into the many difficulties encountered in performing this type of research.

The first chapter introduces concepts which are evaluated in some depth later in the book. While underlining the importance of the use of precise definitions of both violence and mental disorder in the literature, it highlights the limitations of rigidly adhering to psychiatric classifications and advocates a more symptom-based approach. It offers a succinct review of the evidence for the benefits of clinical and/or actuarial methods of risk prediction. It summarises the lessons to be learned from the independent, often public inquiries into homicides committed by people with a history of mental health problems now mandatory in the UK. An insight into public attitudes to the violence risk posed by the mentally ill is provided by a review of population survey and media reports.

Chapter 2 is particularly impressive. It provides the most structured and concise yet critical appraisal of the evidence for the relationship between mental disorder and violence that I have read anywhere. Chapter 3 examines sociodemographic and clinical correlates of violence with particularly interesting sections on threat/control-override symptoms, antisocial personality disorder, psychopathy and the until now much neglected issue of social context.

Chapter 4 offers a more complex examination of the internal world of the offender in terms of childhood experience, psychological development and social function. It reviews the implications for assessment and management of violence according to Glasser's 'self-preservative' and 'sadistic' classifications.

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