Assessing potential violence
It is impossible for any clinician to be able to assess with one hundred percent accuracy the likelihood of rare events such as serious violence.
.The following variables are known to be associated with potential violence:
• A history of violence (the single strongest predictor)
• Being male
• Moving house frequently
• Being unemployed
• Living or growing up in a violent subculture
• Abuse of drugs or alcohol
• Low intelligence
• Coming from a violent family
• Having weapons available
• Having victims available
• History of poor impulse control
The most important predictive clinical variable, however, is motive. If you suspect violence, ask the individual the following questions: • Are you angry at anyone?
• Are you thinking about hurting anyone?
If the answer to either of these questions is positive then you also need to ask:
• Who are you angry at, or thinking about hurting?
• When do you think you might hurt (the person mentioned)? • Where will you do this?
• How long have you been thinking this way?
• Are you able to control these thoughts about hurting (the person mentioned)?
• Do you think you would be able to stop yourself from hurting (the person mentioned) if you wanted to?
• For how long do you think you can control your thoughts about hurting (the person mentioned)?
• Have you ever purposely hurt someone in the past?
• (If the answer to the previous question is negative) "How close have you come to hurting someone in the past?
In particular, you also need to consider:
• The individual's history of violence (fights, hurting others, trouble with the police).
• Factors that may weaken self-control (e.g., psychotic illness, paranoid thinking, organic personality disorder such as a frontal lobe syndrome or a limbic epilepsy syndrome, drug or alcohol abuse).
• History of impulsive behaviour. In addition to violence, drug abuse, or alcohol abuse, also consider stealing, shoplifting, sexual indiscretions, binge eating, suicide attempts or threats.
• Lastly, assess the level of intent (as you would with the assessment of suicidal thoughts). For example, specific intent stated in the active voice is more serious than a general threat in the passive voice. It is important to distinguish between levels of increasing concern. For example:
* 1 wish he were dead.
* I'd like to kill that bastard.
* I'll stick a knife in Joe Bloggs if he comes near my house again.
In general, always try to find out as much as possible about the individual's thoughts and state of mind. At the very least find out as much as you need to know to assess whether violence is likely.
Quoted from Andrews & Jenkins (2000) Managing Mental Disorders. Volume 2. World Health Organisation