MacArthur Violence Risk Assessment Study

I work at Oregon State Hospital (OSH) in Salem, OR. It exists because in Oregon as well as most everywhere else, there is an assumption in the legal system (in society in general) that the people who have a mental health diagnosis are more prone to violence than others. This assumption is reflected in the functioning of the Psychiatric Security Review Board (PSRB), the primary instrument of oppression of those with a mental health diagnosis in this state.  This is a direct opposite to reality/ evidence. (See also reports here and here and here. Or here– or even here.)

The best research available is the The MacArthur Community Violence Study, a gigantic longitudinal project spanning several years and thousands of people. This study included 1,136 male and female civil patients between 18 and 40 years old. The project monitored violence to others every 10 weeks during their first year after discharge from a mental institution. Patient self-reports were augmented by reports from collaterals and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks.

The most comprehensive study ever done regarding mental health and risk of violence found that even among the “mentally ill” who commit violent crimes, the likelihood of that person committing further violence is considerably less than an individual who has no mental health diagnosis. For individuals who simply have a mental health diagnosis, the likelihood that they will commit an act of violence is substantially less than the average person.

(The MacArthur study is so named because major funding was provided by the John D. and Catherine T. MacArthur Foundation’s Research Network on Mental Health and the Law with a supplemental grant from the National Institute of Mental Health (grant # R01 49696) to interview the collateral informants.)

One factor is that many people who have behaviors labeled as mental illness have developed these symptoms as a result of (and a coping mechanism for) being victims of violence. Having a “mental illness” actually conveys a certain degree of immunity from any tendency towards violence.

The one variable that really messes up this finding is substance abuse. People who have both “mental illness” and active substance abuse are more likely to commit violent crimes.

Judging risk of violence by public opinion is as worthwhile as using your horoscope

It would make sense that if people have adequate support in their community they would be less likely to use alcohol or street drugs to self-medicate. In this way the mental health system as it exists in the United States today contributes to violence.

So- I propose that Oregon do the following:

1. Reform the PSRB system- starting with the elimination of the PSRB.
2. Eliminate the State Hospital (and quit building the new replacement facility- maybe the building could be turned into something else- another prison?).
3. Use the money saved to create a system of community services that is fully funded, consumer driven and based on a compassionate, recovery oriented ethic.
4. Create an emergency/ acute care system that is based on the Sanctuary model, that makes use of natural/ holistic medicine and provides a variety of choices in terms of treatment styles and settings.

Meanwhile, I won’t hold my breath. The public perception of those of us with “mental illness” is such that fear over-rides sense. A inmate escaping from the State Prison merits 2 inches of news space on page 6. A patient who leaves OSH (“absconds”) without PSRB permission is front page, lead story and a week of prominent follow-up articles.