Violent behavior preceding hospitalization among persons with severe mental illness

The need to better understand and manage risk of violent behavior among persons with severe mental illness (SMI) in community care is increasingly being recognized. Of particular concern is a subset of the SMI population characterized by a "revolving door" pattern of institutional recidivism and poor 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 major mood disorders who were placed on involuntary outpatient commitment in North Carolina. By pooling baseline data from respondents' self-report, collateral informant interviews, and hospital records, the study found violent behavior 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 when incidents occurred, initiation of fights, settings, relationship to others involved, and associated threat of victimization. Multivariable analyses showed that cooccurring substance abuse problems, history of criminal victimization, and age (being younger) were significantly associated with violent behavior when all sources of data were taken into account. Clinical diagnosis and symptom variables were not related to violence in this sample. Implications of these findings for service delivery priorities and future research are discussed.