Community members risk a great risk of getting themselves hurt at the hands of people prone to violence. The relevance of the study is that it highlights what is instrumental in determining the extent to which mentally ill and violent individuals are likely to pose risk to members of communities, be they prison, hospital or standard civilian groups of people. The literature review will include a board concept of community. Samuel (2015) defined the concept of community as applicable to a human group sharing a geographical area. Following this logic, the notion is possible to apply to patients and inmates at medical and correctional facilities. As early studies as that of Clemmer (1940) viewed a group of inmates as the prison community, as all prisoners undergo specific experience while inside (Blomberg and Lucken, 2011).
Thus, it is logical to consider the evaluation of assessment tools within such groups as such that are applied within prison communities. However, both groups deemed as specific community members have mobility allowing them to reintegrate in traditional civil communities following their discharge from respective institutions. Besides, researchers do not always specify where it is that the subjects of their study are at the time. They may stay within communities under some supervision. Thus, risk assessment tools predict danger they pose to traditional and communities or groups of people within specific correctional and medical establishments. The applicability of the tools to institutional violence risk assessment concerns such facilities. Furthermore, even if some scholars focused on using the tools in isolated communities, they are applicable for mentally disordered or offenders’ reintegration in normal communities. Besides the three community categories, in which individuals can make their violent behavior felt, a great emphasis is made on borderline personality disorder. The overall point is that tools applied to assess the risk mentally ill and violent individuals pose to the community, whether in facilities or otherwise, are of variable value, as follows from the multiple studies in the field.
Methodology
Results
CORE and Acute-on-Chronic Model for BPD Individuals
When it comes to borderline personality disorder, National Institute of Mental Health (n.d.) confirmed that BPD was a serious mental illness characterized by unstable relationships, conduct, and moods. Whewell and Bonanno (2000) dedicated their research to studying individuals suffering from borderline personality disorder. After researching the risk-subscale-based psychotherapy evaluation questionnaire called CORE or the Clinical Outcomes in Routine Evaluation System, they arrived at a conclusion that the tool is both easy to employ and valid doing a good job helping community mental health teams evaluate and manage risks associated with BPD patients. Gunderson (2009) analyzed the acute-on-chronic model of suicide risk evaluation, based on which the level of risk is contingent on factors, such as recent negative events, patients being at discharge, substance abuse, and major depression enhancing the risk, as compared with hospitalization, low-dose antipsychotics, problem-solve alternatives, and crisis skills reported to prevent the acute exacerbation of risk mitigating it. Links, Soloff, and Schiavone (2014) cited all of the mentioned risk enhancing factors but recent negative events and mentioned distraction approaches and self-soothing skills as risk mitigation factors of the model.
ARAIs and PRISM
Maden and Tyrer (2003) and Tyrer (2004) defined ARAIs as a tool applied for evaluating whether individuals released into communities are ready therefor (as cited in Hart, Michie, and Cook, 2007). In Wales and England, the instrument allows physiologists and psychiatrists to make the commitment decision. Janus (2000) and Hart (2003) revealed that Americans apply it to sexual offenders (as cited in Hart, Michie, and Cook, 2007). Hart (2001, 2003) concluded that the tool did no more than conceptualize the risk of violence regarding future violence likelihood, without so much as considering other risk aspects like the frequency, longevity, imminence, severity, and nature of future violence (as cited in Hart, Michie, and Cook, 2007). More to risk assessment associated with committal, Murray and Thomson (2010) defined PRISM as Promoting Risk Intervention by Situational Management suggesting that it does a good job assessing institutional and situational violence. Of similar opinion are Cooke, Johnstone, and Gadon (2008) describing PRISM as facilitating the detailed evaluation of factors related to situational risk across different prisons.
Other Assessment Tools
Dolan and Doyle (2000) scrutinized four clinical risk assessment instruments, the first being DBRS or the dangerous behavior rating scale that consists of 18 ratings of lifestyle-related variables, situation, personality, and interview-specific factors thought to have bearing on risk. The predictive validity is a meager success. As follows from the 6-year follow-up study of 162 of mentally disordered individuals from communities and institutions conducted by Menzies and Webster (1995), weak was the link between clinical and actuarial risk factors and follow-up violence outcome data (as cited in Dolan and Doyle, 2000). The tool components demonstrates less predictive potential than characteristics like employment status, violent history, or age do. Webster et al. (1997a) viewed limited literature, upon which the tool rests, is the reason for instrument limitations and rare application.
Hart (1998a) is among the researchers showing the utility of the PCL-R or Psychopathy Checklist Revised in the way of predicting violence in North American prison communities and identifying recidivists (as cited in Dolan and Doyle, 2000). Grann et al. (1999) visualized that the same held true for offenders in Europe by using the approach to track violent recidivism in Sweden 2 years following release from detention for individuals with personality disorder, the tool considered the best in the circumstances (as cited in Dolan and Doyle, 2000). Hart et al. (1995) reported the tool replaced with 12-item screening version abbreviated as PCL-SV (as cited in Dolan and Doyle, 2000). With similar psychometric properties in place, the tool is praised by Monahan et al. (2000) for its good predictive validity for community violence (as cited in Dolan and Doyle, 2000).
Fazel, Singh, Doll, and Grann (2012) held that sexual offense predictive tools showed lower efficiency coefficient due to negative predictive values and high sensitivities the researchers identified. Thus, sexual wrongdoing predicting instruments like SVR-20, Static-99, and SORAG and any criminal wrongdoing predictors like PCL-R and LSI-R were found to be inferior to VRAG or the Violence Risk Appraisal Guide, SAVRY or the Structured Assessment of Violence Risk in Youth, SARA or the Spousal Assault Risk Assessment, and HCR-20 that are violent offending prediction tools. Similarly to Fazel et al. (2012), Campbell, French, and Gendreau (2007) also admitted LSI-R utility, all the while pointing to it not having norms for violence risk in the way it did the ones for general recidivism.
Murray and Thomson (2010) also found that SORAG and VRAG were the most fitting tools for assessing risks associated with the evaluation of male sexual offenders and recidivism for violent offenders respectively. HCR was very helpful in assessing the violence risk across a wide range of settings. Dolan and Doyle (2000), however, praise the HCR-20 or the Historical/Clinical/Risk Management 20-item scale. Data on the tool is indicative of its showing better than chance correlation between violent outcomes and HCR-20 scores. Harris, Rice, and Camilleri (2004) agreed that VRAG was a good predictor for up to a decade. However, Rice and Harris (1997) questioned the value of VRAG in terms of the prediction of violent sexual recidivism likelihood within the cluster of pedophile sex offenders (as cited in Dolan and Doyle, 2000). Dolan and Doyle (2000) stressed that instrument reliance on rather static factors was the rationale behind criticism.
How Studies Correlate
One of the ways in which the studies differ is the scope of focus. While considering the utility of assessment tools, Whewell and Bonanno (2000) studied three groups of risks while Gunderson (2009) did the one evaluating suicidal risks. Fazel, Singh, Doll, and Grann (2012), in turn, conducted the most comprehensive of the compiled studies by including an enormous cohort of mentally ill patients of close to 25.000 participants from over a score of countries. While Fazel, Singh, Doll, and Grann (2012) compiled data from studies between 1995 and 2011, Dolan and Doyle (2000) seems to have gone possibly farthest towards giving the evaluation study a greater depth by citing data from studies dating from at least 1974. Notable is the solidarity and opposition towards the utility of the same instruments.
Thus, although admitting the viability of the LSI-R tool, Campbell, French, and Gendreau (2007) and Fazel, Singh, Doll, and Grann (2012) pointed to its limitations. Harris, Rice, and Camilleri (2004) and Fazel, Singh, Doll, and Grann (2012) shared the view that VRAG was an efficient risk predictor, the former also determining the longevity of prediction accuracy. Gunderson (2009) and Links, Soloff, and Schiavone (2014) appear to be mutually complementary, as both revealed their unique risk mitigating factors of the assessment model or tool although the former provided a larger set of factors while enhancing factors coincide. Dolan and Doyle (2000) and Fazel, Singh, Doll, and Grann (2012) both considered PCL-R tool in their respective studies as an efficient approach. Still, Dolan and Doyle (2000) questioned the VRAG tool defined by Fazel, Singh, Doll, and Grann (2012) in their extensive research as being excellent at assessing the risk of violent offensive conduct. Both groups of researchers seem to agree on the value of HCR-20 as an assessment tool.
Recommendations and Concluding Remarks
The strength of the research of Dolan and Doyle (2000) lies in their synthesis of various empirical studies acting as a body of evidence disproving or confirming the validity of specific techniques. However, plenty of other studies covered also feature a rich compilation of sources from preceding decades. One of arguably the biggest merits is the attempt made by researchers like Fazel, Singh, Doll, and Grann (2012) of including scores of thousands of the studied in different countries, which makes for a more efficient evaluation of tools efficiency. The strength of studies is also in their coverage of tools utility analysis in both America and Europe alike, the testing of the instrument in different contexts, be they medical, detention facilities or normal non-prison communities. No contradictions were spotted except that different sources had sometimes-contrasting views as to the utility of any given tool. There is no contradiction in the fact that some sources admit the utility of the same tool while other do not. Indeed, although instruments like VRAG receive positive feedback based on their predictive potential, there still are some researchers questioning its validity. While all of the tools have their unique value if applied in specific cases, there is one psychiatrists are discouraged from using. Actuarial risk assessment instruments seem to be the only tool that has garnered criticism on the part of the scientific community recommending limiting its application except on separate occasions. The fear is that it does little to predict violence recidivism risk.
While the studies may look quite exhaustive, much remains to be researched. A deeper investigation into the use of tools and the value of their application in British communities is needed since research on other countries is in abundance. Researchers themselves clearly point to the shortcomings of their efforts. Thus, Fazel, Singh, Doll, and Grann (2012) admit to having examined just the predictive qualities of risk evaluation instruments, without rationalizing their potential role in reminding clinicians of the need to investigate essential modifiable and prognostic factors. Thus, research curators need to see it done the integration of the factors in the analysis, so that their predictive value may not go to waste. Campbell, French, and Gendreau (2007) recommended that there be more of detailed aspects of violence risk along with violence occurrence conditions in the studies to be produced. At this point, vagueness in the general estimate of violence risk is none to useful. The impact of protective factors that may moderate or mediate the link between violent risk and criminogenic factors still goes neglected as an assessment aspect.
References
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Cooke, D.J., Johnstone, L., and Gadon, L. (2008). Situational risk factors and institutional violence. Scottish Prison Service. Retrieved from: http://www.sps.gov.uk/nmsruntime/saveasdialog.aspx?fileName=SPS_Research_Report_-_Situational_Risk_Factors_-_Volume_2.doc
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