Dangerousness and violence in hospitalized mentally ill offenders

Clinical judgments of dangerousness depend not only on patient characteristics, but are greatly influenced by the perspective of the rater and the context for which the assessments are made. Similarly, institutional violence is determined not only by patient characteristics, but is also a function of contextual variables such as physical milieu, important clinical events not under the control of the patient, etc. To increase the predictive validity of assessments of dangerousness it is essential to specify the vulnerabilities and strengths of the patient, the current life stressors, and the contextual triggers to which the patient is likely to react violently. The momentary contextual triggers may be useful to predict the type and severity of violence and perhaps the most likely victims as well. Analyses of previous violent incidents may provide markers for contextual triggers, e.g., type of weapon, victim, severity of violence, etc.