The violence relapse process – a qualitative analysis of high-risk situations and risk communication in mentally disordered offenders

Abstract

Approximately 45% of mentally disordered offenders relapse into violence. Although much is known about factors related to the risk of future violence, the violence relapse process is still in many aspects an unexplored area. The aim of this study was to increase the knowledge of the recidivism process and risk communication of the repeatingly violent mentally disordered offender. A qualitative study using open-ended, semi-structured interviews was conducted with 14 mentally disordered offenders who had relapsed into violent behaviour. Important risk markers, pointed out by the informants, such as separations, drug problems, homelessness, and lack of sleep, were presented in a situational context. All but one of the informants were of the opinion that they directly or indirectly had communicated their violent intent or the experience of an intolerable situation. These results may help practitioners to target interventions and prevent further violence.

Keywords:

• Violence
• relapse process
• risk factors
• risk communication
• mental disorders
• qualitative research

Notes

1 “Mentally disordered offenders” will in this paper refer to individuals convicted of crimes with a diagnosis of mental illness or other psychiatric disorder.

2 In Sweden, offenders can be referred to compulsory in-patient care (instead of being convicted to imprisonment) if the court decides, on the basis of the forensic psychiatric investigation, that the crime was committed while suffering from a serious mental disorder and that the offender is in need of in-patient psychiatric treatment. Under certain circumstances, the patient may be obliged to undergo medication during compulsory treatment.

3 In the table, the informants have been separated into two groups based on how the violence was committed as in-patient violence or violence in the community, to display the heterogeneity of the study group.

4 Throughout this paper, the term “risk marker” is used as a generic term to refer to any condition or environmental exposure that the informants have pointed out to have a direct or causal effect on the risk of future violence. Further, antecedents are used to describe risk markers with a distant time relationship to violence and triggers are used to exemplify risk markers presented closer in time to the violent failure. The conceptualization of a “risk marker” and “trigger” is actually much more complex than this. In epidemiological research, the term “risk marker” is reserved for describing parameters with an indirect causal relation (Kraemer et al., 1997). The term “trigger” is used for describing an unusual factor with an immediate and transient effect and with a causal relationship to the outcome (Maclure & Mittleman, 2000).

5 Significant others are defined as cohabitants or persons in close and continuous contact with the informant and who were important to them.