The relationship between violence, level of functioning, and treatment outcome in psychiatric inpatients
| DOI | https://doi.org/10.1108/JFP-05-2013-0033 |
| Date | 04 November 2014 |
| Published date | 04 November 2014 |
| Pages | 295-303 |
| Author | Irram Walji,Vincent Egan,Andres Fonseca,Adam Huxley |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
The relationship between violence,
level of functioning, and treatment
outcome in psychiatric inpatients
Irram Walji, Vincent Egan, Andres Fonseca and Adam Huxley
Irram Walji is a Trainee Clinical
Psychologist, based at Clinical
Psychology – Division of Health
Research, Lancaster
University, Lancaster, UK.
Vincent Egan is an Associate
Professor in Forensic
Psychology Practice, based at
Centre for Family and Forensic
Psychology, Department of
Psychiatry and Applied
Psychology, University of
Nottingham, Nottingham, UK.
Dr Andres Fonseca is a
Consultant Psychiatrist, based
at Cambridgeshire and
Peterborough NHS Foundation
Trust, Peterborough, UK.
Dr Adam Huxley is a
Consultant Clinical Forensic
Psychologist, based at
Department of Clinical
Psychology, Cambian Group,
London, UK.
Abstract
Purpose – There is an association between the diagnosis of a mental illness and violent behaviour.
Individuals diagnosed with severe and enduring mental health difficulties who display violent behaviour have
inferior treatment outcomes when compared with those who do not engage in violent behaviour. Violent
behaviour within care settings impacts on general functioning, adherence to treatment plans, and inhibits
wider recovery goals. The paper aims to discuss these issues.
Design/methodology/approach – This research studied 95 inpatients with a primary diagnosis of severe
mental illness, with and without a history of violence, and compared how levels of global functioning and risk
impacted on recovery. Patients were divided into two groups: those with and without a previous or current
history of violence. The two groups were compared on measures of global functioning, symptomatology,
and risk at baseline and 12-month follow up.
Findings – Both violent and non-violent groups showed increased global functioning over time, with no
significant difference between the groups. Neither group showed significant reductions in risk over time.
Patients in the violent group had significantly fewer prior and current symptoms of mental ill-health than
non-violent individuals.
Research limitations/implications – Despite evidence suggesting that historical or current violence leads
to impaired outcomes amongst people with diagnoses of mental illness, the findings of this study suggest a
history of violent behaviour was not a predictor of poor progress within inpatient settings.
Practical implications – Disconfirming previous hypotheses, the paper suggests that in itself, violent
behaviour does not always significantly impair outcomes for individuals diagnosed with mental illnesses, and
that many other variables contribute to meaningful recovery.
Originality/value – Whilst there are previous studies investigating outcomes for inpatients diagnosed with
mental illness who have violent histories, there is a dearth of research comparing equivalent groups in the
same facility over the same time period. This study directly compared inpatients with or without a history of
violence in the same psychiatric rehabilitation settings.
Keywords Violence, Psychosis, Treatment outcome, Mental illness, Mental health, Behaviour
Paper type Research paper
Introduction
Psychiatric rehabilitation aims to reduce impairment and disability caused by severe and
enduring mental health difficulties by promoting recovery. This is achieved through evidence
based pharmacological, psychological, and occupational interventions (Craig, 2006) that
promote life skills to encourage independence with a view to discharge into less restrictive
settings (Kopelowicz et al., 2003). Rehabilitation programs are typically offered over longer
periods of time as continuity of service and intensity of therapeutic input promotes better
outcomes in clinical and psychosocial functioning (Brekke et al., 1999). Understanding violence
committed by people with diagnoses of mental illness has become a priority for modern mental
health services (Douglas et al., 1999). Violent behaviour often precludes successful integration
DOI 10.1108/JFP-05-2013-0033 VOL. 16 NO. 4 2014, pp. 295-303, CEmerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAGE 295
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