The challenge of preventing violence is not just an American problem


The challenge of preventing violence is not just an American problem



<b>John Monahan and Jeffrey Swanson
Sunday April 22, 2007</b>
<a href=",,2062866,00.html">The Observer</a>

One of the largest mass killings in American history was carried out last Monday at the hands of a 23-year-old university student with mental illness. The reverberations of the events that ended the lives of 32 students and faculty staff at Virginia Tech - and of the offender as well - are shaking the already wobbly mental health system. This American tragedy surely holds lessons for the UK as it considers the revision of its Mental Health Bill. The scientific challenges of predicting violence, and the legal challenges of preventing it, transcend national borders.
Both UK and US look first to mental health professionals. But how good are psychiatrists and psychologists at distinguishing which people with a mental illness will be violent? Research shows professionals are better than pure chance, but not much. Predicting harmful behaviour is like predicting bad weather. An inaccurate prediction doesn&#39;t necessarily mean the clinician or the meteorologist has &#39;missed something&#39;; it may just mean the science of forecasting has a long way to go.

Tools to aid mental health professionals in the task focus on proven risk factors: characteristics that define the person (e.g. young, male); disorders that a person has (e.g. a major mental illness, a personality disorder, and alcohol or drug abuse); what the person has done (e.g. past violence); and what has been done to the person (e.g. being raised by violent or substance abusing parents, and being physically abused as a child). These risk factors can distinguish patients with a low risk of future violence from patients with a high one.

What can be done to preclude anticipated violence? If people need treatment, don&#39;t want it, and might do something harmful if they don&#39;t get it, can the state override their right to refuse? The law of civil commitment - being hospitalised against one&#39;s will - in almost every US state focuses on two things: whether the person is seriously mentally ill and whether they are likely to be imminently violent to self or others. Many states have recently struck the word &#39;imminently&#39; from their statutes as being too restrictive.

There are many state laws authorising &#39;outpatient commitment&#39;, or in Britain &#39;community treatment orders&#39;, requiring certain people to get treatment in the community rather than, or in addition to, in a hospital. Cho himself had received a judicial order in December 2005 to &#39;follow all recommended treatment&#39;. In Virginia, however, such an order is effectively unenforceable.

Civil libertarians see these laws as an Orwellian intrusion on the freedom of people with mental illness, most of whom will never be violent, to make their own decisions about treatment. But family members often argue that their relatives are so sick they don&#39;t realise they&#39;re ill and won&#39;t accept treatment voluntarily, or will stop taking their medication or therapy when they feel better.

They argue that some people have to be required by law to accept outpatient treatment, or they won&#39;t get any treatment at all, sometimes with catastrophic effect. In Cho&#39;s case, opponents will argue that the outcome proves a judicial order to community-based treatment cannot prevent murder and mayhem; proponents will say that these statutes need more &#39;teeth&#39;.

But this controversy raises the question of whether the policy actually works: can legally enforced outpatient treatment prevent violence? Evidence is mixed. However, one study found that if people with mental illness were on a community treatment order for at least six months, they were much less likely to be violent than people who were not on outpatient commitment or on it only briefly.

As the science of violence risk assessment improves, and clinical interventions to reduce that risk become demonstrably effective, there will be no avoiding trade-offs among cherished Anglo-American values of autonomy, social responsibility, privacy, and security. Our advice is to beware all those who find these trade-offs easy. In the process of defining the rights and responsibilities of those among us with mental illness, we define ourselves.

John Monahan is a psychologist and University of Virginia professor. Jeffrey Swanson is a sociologist and associate professor at the Duke University School of Medicine.

<B>On Guardian Unlimited</B><BR><A HREF="">Full coverage of the Virginia Tech shootings</A><BR><A HREF=",,182056,00.html">Gun violence in the US</A><BR><A HREF=",,178412,00.html">Gun violence in Britain</A><BR><A HREF=",,759893,00.html">Full US coverage</A><BR><BR><B>Related articles</B><BR><A HREF=",,2059217,00.html">Virginia massacre gunman named</A><BR><A HREF=",,2059103,00.html">Unofficial list of shooting victims emerges</A><BR><A HREF=",,2058887,00.html">Massacre on campus</A><BR><A HREF=",,2059250,00.html">Q&A: US gun laws</A><BR><BR><B>World news guide</B><BR><A HREF=",,618255,00.html">North American Media</A><BR><BR><B>Media</B><BR><A HREF="">CNN</A><BR><A HREF="">New York Times</A><BR><A HREF="">Washington Post</A><BR><BR><B>Government</B><BR><A HREF="">Virginia state government portal</A><BR><A HREF="">US government portal</A><BR><A HREF="">White House</A><BR><A HREF="">Senate</A><BR><A HREF="">House of Representatives</A>

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John Monahan and Jeffrey Swanson




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John Monahan and Jeffrey Swanson, “The challenge of preventing violence is not just an American problem,” The April 16 Archive, accessed June 24, 2024,