Non-pharmacological Approaches to Violence Among People with Severe Mental Disorders

  • Antonio VitaEmail author
  • Valentina Stanga
  • Anna Ceraso
  • Giacomo Deste
  • Stefano Barlati
Part of the Comprehensive Approach to Psychiatry book series (CAP, volume 1)


Although public perception believes that severe mental illness (SMI) and violence are tightly associated, the research evidence to support such a relationship is mixed, and most people with SMI are never violent. Although the relative contribution of psychiatric morbidity to violent behaviour remains a controversial area of research, recent data have shown that there is a consistent, albeit modest, positive association between SMI and violence. Although pharmacological treatment is necessary, it is insufficient on its own in preventing forthcoming aggression episodes. Although a wide number of non-pharmacological interventions have been adopted for SMI offenders, evidence on their effectiveness is weak and not conclusive. This chapter reviews the available evidence on non-pharmacological interventions in reducing violence in adults with SMI. We included both the interventions aimed at managing aggression in acute situations, and the strategies aimed at preventing and reducing its recurrence over time.


Severe mental illness Mentally disordered offenders Violence Aggressive behaviour Non-pharmacological intervention Psychosocial intervention Integrated intervention 


  1. 1.
    Choe JY, Teplin LA, Abram KM. Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatr Serv. 2008;59(2):153–64.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;375(7):e14.PubMedCrossRefGoogle Scholar
  3. 3.
    Barlati S, Stefana A, Bartoli F, Bianconi G, et al. Violence risk and mental disorders (VIORMED-2): a prospective multicenter study in Italy. PLoS One. 2019;14(4):e0214924.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Iozzino L, Ferrari C, Large M, Nielssen O, De Girolamo G. Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS One. 2015;10:e0128536.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Swanson JW, McGinty EE, Fazel S, Mays VM. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol. 2015;25:366–76.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):487–503.CrossRefGoogle Scholar
  7. 7.
    Pompili E, Carlone C, Silvestrini C, Nicolò G. Focus on aggressive behaviour in mental illness. Riv Psichiatr. 2017;52(5):175–9.PubMedGoogle Scholar
  8. 8.
    Iennaco JD, Dixon J, Whittemore R, Bowers L. Measurement and monitoring of health care worker aggression exposure. Online J Issues Nurs. 2013;18(1):3.0.Google Scholar
  9. 9.
    Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying and sexual harassment: a quantitative review. Int J Nurs Stud. 2014;51(1):72–84.PubMedCrossRefGoogle Scholar
  10. 10.
    Galiàn-Muños I, Ruiz-Hernàndez JA, et al. User violence and nursing staff burnout: the modulating role of job satisfaction. J Interpers Violence. 2014;31(2):302–15.CrossRefGoogle Scholar
  11. 11.
    Gates DM, Gillespie GL, Succop P. Violence against nurses and its impact on stress and productivity. Nurs Econ. 2011;29(2):59–66.PubMedGoogle Scholar
  12. 12.
    Roche M, Diers D, Duffield C, Catling-Paull C. Violence toward nurses, the work environment and patient outcomes. J Nurs Scholarsh. 2010;42(1):13–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Rubio-Valera M, Luciano JV, Ortiz JM, et al. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry. 2015;15:35.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Joyal CC, Côté G, Meloche J, Hodgins S. Severe mental illness and aggressive behaviour: on the importance of considering subgroups. Int J Forens Ment Health. 2011;10:107–17.CrossRefGoogle Scholar
  15. 15.
    Wong SCP, Olver ME. Risk reduction treatment of psychopathy and applications to mentally disordered offenders. CNS Spectr. 2015;20:303–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Fazel S, Zetterqvist J, Larsson H, Långström N, Lichtenstein P. Antipsychotics, mood stabilisers and risk of violent crime. Lancet. 2014;374:1206–14.CrossRefGoogle Scholar
  17. 17.
    Large M, Nielssen O. Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res. 2011;125(2-3):209–20.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Witt K, Van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS One. 2013;8:e55942.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Volavka J. Violence in schizophrenia and bipolar disorder. Psychiatr Danub. 2013;25(1):24–33.PubMedGoogle Scholar
  20. 20.
    Elbogen EB, Mustillo S, Van Dorn R, Swanson JW, Swarts MS. The impact of perceived need for treatment on risk of arrest and violence among people with severe mental illness. Crim Justice Behav. 2007;34:197–210.CrossRefGoogle Scholar
  21. 21.
    Müller-Isberner R, Sheilagh H. Evidence-based treatment for mentally disordered offenders. In: Violence, crime and mentally disordered offenders. Chichester: John Wiley & Sons Ltd.; 2000.Google Scholar
  22. 22.
    Economou M, Palli A, Falloon IRH. Violence, misconduct and schizophrenia: outcomes after four years of optimal treatment. Clin Pract Epidemiol Ment Health. 2005;1:3.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Nishinaka H, Nakane J, Nagata T, et al. Neuropsychological impairment and its association with violence risk in Japanese forensic psychiatric patients: a case-control study. PLoS One. 2016;11(1):e0148354.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Richter MS, O’Reilly K, O’Sullivan D, et al. Prospective observational cohort study of treatment as usual over four years for patients with schizophrenia in a national forensic hospital. BMC Psychiatry. 2018;18:289.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Rampling J, Furtado V, Winsper C, Marwaha S, Lucca G, Livanou M, Singh SP. Non-pharmacological interventions for reducing aggression and violence in serious mental illness: a systematic review and narrative synthesis. Eur Psychiatry. 2016;34:17–28.PubMedCrossRefGoogle Scholar
  26. 26.
    Blackburn R. “What works” with mentally disordered offenders. Psychol Crime Law. 2004;10(3):297–308.CrossRefGoogle Scholar
  27. 27.
    Ross J, Quayle E, Newman E, et al. The impact of psychological therapies on violent behaviour in clinical and forensic settings: a systematic review. Aggress Violent Behav. 2013;18:761–73.CrossRefGoogle Scholar
  28. 28.
    Quinn J, Kolla NJ. From clozapine to cognitive remediation: a review of biological and psychosocial treatments for violence in schizophrenia. Can J Psychiatry. 2017;62(2):94–101.PubMedCrossRefGoogle Scholar
  29. 29.
    Hallett N, Dickens GL. De-escalation of aggressive behaviour in healthcare settings: concept analysis. Int J Nurs Stud. 2017;75:10–20.PubMedCrossRefGoogle Scholar
  30. 30.
    National Institute for Health and Clinical Excellence (NICE). Violence: the short term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments national cost-impact report. London: National Institute for Clinical Excellence; 2005.Google Scholar
  31. 31.
    Paterson B, Leadbetter D, Miller G. Workplace violence in health and social care as an international problem: a public health perspective on the total organisational response. Available; 2004.
  32. 32.
    Bowers L. A model of de-escalation. Ment Health Pract. 2014;17(9):36–7.CrossRefGoogle Scholar
  33. 33.
    Davidson J, Wood C. A conflict resolution model. Theory Pract. 2004;43(1):6–13.CrossRefGoogle Scholar
  34. 34.
    Leadbetter D, Paterson B. De-escalating aggressive behaviour. In: Kidd B, Stark C, editors. Management of violence and aggression in health care. London: Gaskell; 1995. p. 49–84.Google Scholar
  35. 35.
    Maier GJ, Van Rybroek GJ. Managing counter transference reactions to aggressive patients. In: Eichelman BS, Hartwig AC, editors. Patient’s violence and the clinician. Washington DC: American Psychiatric Press Inc.; 1995.Google Scholar
  36. 36.
    De Dreu CKW, Weingart LR. Task versus relationship conflict, team performance, and team member satisfaction: a meta-analysis. J Appl Psychol. 2003;88(4):741–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Hücker F. Rhetorische Deeskalation. Stuttgart: Boorberg; 1997.Google Scholar
  38. 38.
    Nay WR. Taking charge of anger: how to resolve conflict, sustain relationships, and express yourself without losing control. New York, London: Guilford Publications; 2003.Google Scholar
  39. 39.
    Maier GJ. Managing threatening behaviour: the role of talk down and talk up. J Psychosoc Nurs Ment Health Serv. 1996;34:25–30.PubMedGoogle Scholar
  40. 40.
    Dutschmann A. Aggressionen und konflikte unter emotionaler erregung: deeskalation und Problemlösung (das aggressions-bewaltigungs-programm ABPro). Tübingen DCVT-Verlang; 2000.Google Scholar
  41. 41.
    Miller N, Pedersen WC, Earlywine M, Polock VE. A theoretical model of triggered displaced aggression. Personal Psychol Rev. 2003;7:75–97.CrossRefGoogle Scholar
  42. 42.
    Beech B, Leather P. Evaluating a management of aggression unit for student nurses. J Adv Nurs. 2003;44(6):603–12.PubMedCrossRefGoogle Scholar
  43. 43.
    Richter BD, Warner AT, Meyer JL, Lutz K. A collaborative and adaptive process for developing environmental flow recommendations. River Res Appl. 2006;22(3):297–318.CrossRefGoogle Scholar
  44. 44.
    Bowers L, Flood C, Brennan G, LiPang M, Oladapo P. Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: city nurses. J Psychiatr Ment Health Nurs. 2006;13:165–72.PubMedCrossRefGoogle Scholar
  45. 45.
    Armelius BA, Andreassen TH. Cognitive-behavioral treatment for antisocial behavior in youth in residential treatment. Cochrane Database Syst Rev. 2007;4:CD005650.Google Scholar
  46. 46.
    National Institute for Health and Clinical Excellence (NICE). Antisocial personality disorder: treatment, management and prevention Volume 77. London, UK: National Collaborating Center for Mental Health; 2009.Google Scholar
  47. 47.
    Gibbon S, Duggan C, Stoffers J, Huband N, Völlm BA, Ferriter M, Lieb K. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2010;6:CD007668.Google Scholar
  48. 48.
    Rodrigo C, Rajapakse S, Jayananda G. The ‘antisocial’ person: an insight in to biology, classification and current evidence on treatment. Ann Gen Psychiatry. 2010;9:31.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Davidson K, Tyrer P, Tata P, et al. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychol Med. 2009;39:569–77.PubMedCrossRefGoogle Scholar
  50. 50.
    Làtalovà K, Praško J. Aggression in borderline personality disorder. Psychiatry Q. 2010;81:239–51.CrossRefGoogle Scholar
  51. 51.
    Timmermann IGH, Emmelkamp PMG. The effects of cognitive behavioral treatment for forensic inpatients. Int J Offender Ther Comp Criminol. 2005;49(5):590–606.CrossRefGoogle Scholar
  52. 52.
    Hughes G, Hogue T, Hollin C, Champion H. First-stage evaluation of a treatment programme for personality disordered offenders. J Forensic Psychiatry. 1997;8:515–27.CrossRefGoogle Scholar
  53. 53.
    Gerhart JI, Ronan GF, et al. The moderating effects of Cluster B personality traits on violence reduction training: a mixed-model analysis. J Interpers Violence. 2013;28(1):45–61.PubMedCrossRefGoogle Scholar
  54. 54.
    Ronan G, Gerhart J, Bannister D, Udell C. Relevance of a stage of change analysis for violence reduction training. J Forensic Psychiatry Psychol. 2010;21(5):761–72.CrossRefGoogle Scholar
  55. 55.
    Wykes T, Steel C, Everitt B, et al. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models and methodological rigor. Schizophr Bull. 2008;34(3):523–37.PubMedCrossRefGoogle Scholar
  56. 56.
    Garrett M, Lerman M. CBT for psychosis for long-term inpatients with a forensic history. Psychiatr Serv. 2007;58(5):712–3.PubMedCrossRefGoogle Scholar
  57. 57.
    Frommberger U, Hamann K, Kammerer J, et al. A feasibility study on violence prevention in outpatients with schizophrenia. Int J Law Psychiatry. 2018;58:54–62.PubMedCrossRefGoogle Scholar
  58. 58.
    Haddock G, Barrowclough C, Shaw JJ, et al. Cognitive-behavioural therapy v. social activation therapy for people with schizophrenia and a history of violence: randomized controlled trial. Br J Psychiatry. 2009;194(2):152–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Hodel B, West A. A cognitive training for mentally ill offenders with treatment resistant schizophrenia. J Forensic Psychiatry. 2003;14(3):554–68.CrossRefGoogle Scholar
  60. 60.
    Hornsveld RH, Nijman HL. Evaluation of a cognitive-behavioural program for chronically psychotic forensic inpatients. Int J Law Psychiatry. 2005;28(3):246–54.PubMedCrossRefGoogle Scholar
  61. 61.
    Yates KF, Kunz M, Khan A, et al. Psychiatric patients with histories of aggression and crime five years after discharge from a cognitive-behavioral program. J Forensic Psychiatry Psychol. 2010;21(2):167–88.CrossRefGoogle Scholar
  62. 62.
    Bateman A, O’Connell J, Lorenzini N, Gardner T, Fonagy P. A randomized controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry. 2016;16:304.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Taubner S, White LO, Zimmermann J, Fonagy P, Nolte T. Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. J Abnorm Child Psychol. 2013;41(6):929–38.PubMedCrossRefGoogle Scholar
  64. 64.
    Kuokkanen R, Lappalainen R, et al. Metacognitive group training for forensic and dangerous non forensic patients with schizophrenia: a randomized controlled feasibility trial. Crim Behav Ment Health. 2014;24(5):345–57.PubMedCrossRefGoogle Scholar
  65. 65.
    Low G, Jones D, Duggan C, Power M, Macleod A. The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: a pilot study in a high security hospital. Behav Cogn Psychother. 2001;29:85–92.CrossRefGoogle Scholar
  66. 66.
    McCann RA, Ball EM, Ivanoff AM. Dialectical behaviour therapy with an inpatient forensic population: the CMHIP forensic model. Cogn Behav Pract. 2000;7:447–56.CrossRefGoogle Scholar
  67. 67.
    Trupin EW, Stewart DG, Beach B, Boesky L. Effectiveness of a dialectical behavior therapy program for incarcerated female juvenile offenders. Child Adoles Ment Health. 2002;7(3):121–7.CrossRefGoogle Scholar
  68. 68.
    Scheel KR. The empirical basis of dialectical behaviour therapy: summary, critique and implications. Clin Psychol Sci Pract. 2000;7:1.CrossRefGoogle Scholar
  69. 69.
    Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48:1060–4.PubMedCrossRefGoogle Scholar
  70. 70.
    Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioural treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1993;50:971–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Evershed S, Tennant A, et al. Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison. Crim Behav Ment Health. 2003;13:198–213.PubMedCrossRefGoogle Scholar
  72. 72.
    Keulen-de Vos M, Bernstein DP, Clark LA, et al. Validation of the schema mode concept in personality disordered offenders. Legal Criminol Psychol. 2017;22(2):420–41.CrossRefGoogle Scholar
  73. 73.
    Tarrier N, Dolan M, Doyle M et al. Exploratory randomized clinical trial of schema modal therapy in the personality disorder service at Ashworth Hospital. UK: Ministry of Justice (Research Series 5/10); 2010.Google Scholar
  74. 74.
    Bernstein D, Nijman H, Karos K, Keulen-de Vos M, et al. Schema therapy for forensic patients with personality disorders: design and preliminary findings of a multicenter randomized clinical trial in the Netherlands. Int J Forensic Ment Health. 2012;11:312–24.CrossRefGoogle Scholar
  75. 75.
    Rice ME, Harris GT, Varney GW, Quinsey VL, Cyr M. Planning treatment programmes in secure psychiatric facilities. Law Ment Health. 1990;6:159–87.Google Scholar
  76. 76.
    Chereji SV, Pintea S, David D. The relationship of anger and cognitive distortions with violence in violent offenders’ population: a meta-analytic review. Eur J Psychol Appl Legal Context. 2012;4(1):1–98.Google Scholar
  77. 77.
    Henwood KS, Chou S, Browne KD. A systematic review and meta-analysis on the effectiveness of CBT informed anger management. Aggress Violent Behav. 2015;25:280–92.CrossRefGoogle Scholar
  78. 78.
    Lee AH, Di Giuseppe R. Anger and aggression treatments: a review of meta-analyses. Curr Opin Psychol. 2018;19:65–74.PubMedCrossRefGoogle Scholar
  79. 79.
    Duncan EAS, Nicol MM, Ager A, Dalgleish L. A systematic review of structured group interventions with mentally disordered offenders. Crim Behav Ment Health. 2006;16:217–41.PubMedCrossRefGoogle Scholar
  80. 80.
    Hornsveld RH, Nijman HL. Aggression control therapy for violent forensic psychiatric patients: method and clinical practice. Int J Offender Ther Comp Criminol. 2008;52(2):222–33.PubMedCrossRefGoogle Scholar
  81. 81.
    Wilson C, Gandolfi S, Dudley A, et al. Evaluation of anger management groups in a high-security hospital. Crim Behav Ment Health. 2013;23:356–71.PubMedCrossRefGoogle Scholar
  82. 82.
    Ross R, Fabiano E. Time to think: a cognitive model of delinquency prevention and offender rehabilitation. Johnson City, TN: Institute of Social Sciences and Arts, Inc.; 1985.Google Scholar
  83. 83.
    Berman AH. The reasoning and rehabilitation program: assessing short- and long-term outcomes among male Swedish prisoners. J Offender Rehabil. 2004;40(1/2):85–103.CrossRefGoogle Scholar
  84. 84.
    Tong LS, Farrington DP. Effectiveness of “Reasoning and Rehabilitation” in reducing reoffending. Psicothema. 2008;20:20–8.PubMedGoogle Scholar
  85. 85.
    Joy Tong L, Farrington D. How effective is the “reasoning and rehabilitation” programme in reducing reoffending? a meta-analysis of evaluations in four countries. Psychol Crime Law. 2006;2(1):3–24.CrossRefGoogle Scholar
  86. 86.
    Cullen A, Clarke A, Kuipers E, et al. A multisite randomized trial of a cognitive skills programme for male mentally disordered offenders: violence and antisocial behaviour outcomes. J Consult Clin Psychol. 2012;80(6):1114–20.PubMedCrossRefGoogle Scholar
  87. 87.
    Young S, Chick K, Gudjonsson G. A preliminary evaluation of reasoning and rehabilitation 2 in mentally disordered offenders (R&R 2M) across two secure forensic settings in the United Kingdom. J Forensic Psychiatry Psychol. 2010;21(4):490–500.CrossRefGoogle Scholar
  88. 88.
    Young S, Das M, Gudjonsson G. Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: predictors of outcome. World J Psychiatry. 2016;6(4):410–8.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Rees-Jones A, Gudjonsson G, Young S. A multi-site controlled trial of a cognitive skills program for mentally disordered offenders. BMC Psychiatry. 2012;12:44.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Yip V, Gudjonsson G, et al. A non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness. BMC Psychiatry. 2013;13:267.CrossRefGoogle Scholar
  91. 91.
    Jotangia A, Rees-Jones A, et al. A multi-site controlled trial of the R&R2MHP cognitive skills program for mentally disordered female offenders. Int J Offender Ther Comp Criminol. 2015;59(5):539–59.PubMedCrossRefGoogle Scholar
  92. 92.
    Kingston DA, Olver ME, McDonald J, Cameron C. A randomised controlled trial of a cognitive skills programme for offenders with mental illness. Crim Behav Ment Health. 2018;28:369–82.PubMedCrossRefGoogle Scholar
  93. 93.
    Young S, Hopkin G, Perkins D, et al. A controlled trial of a cognitive skills program for personality-disordered offenders. J Atten Disord. 2013;17(7):598–607.PubMedCrossRefGoogle Scholar
  94. 94.
    Ahmed AO, Hunter KM, Goodrum NM, et al. A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia. J Psychiatr Res. 2015;68:8–18.PubMedCrossRefGoogle Scholar
  95. 95.
    O’Reilly K, Donohoe G, Coyle C, et al. Prospective cohort study of the relationship between neuro-cognition, social cognition and violence in forensic patients with schizophrenia and schizoaffective disorder. BMC Psychiatry. 2015;10(15):155.CrossRefGoogle Scholar
  96. 96.
    Darmedru C, Demily C, Franck N. Cognitive remediation and social cognitive training for violence in schizophrenia: a systematic review. Psychiatry Res. 2017;251:266–74.PubMedCrossRefGoogle Scholar
  97. 97.
    Doyle M, Khanna T, Lennox C, Shaw J, Hayes A, et al. The effectiveness of an enhanced thinking skills programme in offenders with antisocial personality traits. J Forensic Psychiatry Psychol. 2013;24(1):1–15.CrossRefGoogle Scholar
  98. 98.
    Tapp J, Fellowes E, Wallis N, Blud L, Moore E. An evaluation of the Enhanced Thinking Skills (ETS) programme with mentally disordered offenders in a high security hospital. Legal Criminol Psychol. 2009;14:201–12.CrossRefGoogle Scholar
  99. 99.
    Chan SW, Yip B, Tso S, Cheng B, Tam W. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Educ Couns. 2009;75(1):67–76.PubMedCrossRefGoogle Scholar
  100. 100.
    Paranthaman V, Satnam K, Lim J, Amar-Singh HS, Sararaks S, et al. Effective implementation of a structured psychoeducation programme among caregivers of patients with schizophrenia in the community. Asian J Psychiatr. 2010;3(4):206–12.PubMedCrossRefGoogle Scholar
  101. 101.
    Komala EPE, Keliat BA, et al. Acceptance and commitment therapy and family psycho education for clients with schizophrenia. Enferm Clin. 2018;28(Supl1 Part A):88–93.CrossRefGoogle Scholar
  102. 102.
    Thylstrup B, et al. Psycho-education for substance use and antisocial personality disorder: a randomized trial. BMC Psychiatry. 2015;15:285.CrossRefGoogle Scholar
  103. 103.
    Nurenberg JR, Schleifer SJ, Shaffer TM, et al. Animal-assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behaviour. Psychiatr Serv. 2015;66(1):80–6.PubMedCrossRefGoogle Scholar
  104. 104.
    Bruce M, Crowley S, et al. Community DSPD pilot services in South London: rates of reconviction and impact of supported housing on reducing recidivism. Crim Behav Ment Health. 2014;24:129–40.PubMedCrossRefGoogle Scholar
  105. 105.
    Ramesh T, Igoumenou A, Vazques Montes M, Fazel S. Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis. Eur Psychiatry. 2018;52:47–53.PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Brook M. Structured approaches to violence risk assessment: a critical review. Psychiatric Annals. 2017;47(9):454–9.CrossRefGoogle Scholar
  107. 107.
    Commane C, Toal F, Mullen P, Ogloff J. Take home notes: risk assessment and management of violence in general adult psychiatry. CPD Online; 2019.Google Scholar
  108. 108.
    Douglas T, Pugh J, Singh I. Risk assessment tools in criminal justice and forensic psychiatry: the need for better data. Eur Psychiatry. 2017;42:134–7.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Nielssen O. Preventing violence in schizophrenia. Evid Based Psychiatr Care. 2015;1:15–8.Google Scholar
  110. 110.
    Large M, Ryan C, Callaghan S, Paton M, Singh S. Can violence risk assessment really assist in clinical decision-making? Aust N Z J Psychiatry. 2014;48:286–8.PubMedCrossRefGoogle Scholar
  111. 111.
    Abderhalden C, Needham I, Dassen T. Structured risk assessment and violence in acute psychiatric wards: randomized controlled trial. Brit J Psychiatry. 2008;193(1):44–50.CrossRefGoogle Scholar
  112. 112.
    Kaunomäki J, Jokela M, et al. Interventions following a high risk assessment score: a naturalistic study on a Finnish psychiatric admission ward. Health Serv Res. 2017;17:26.CrossRefGoogle Scholar
  113. 113.
    Fazel S, Långström N, Hjern A, et al. Schizophrenia, substance abuse, and violent crime. JAMA. 2009;301(19):2016–23.PubMedPubMedCentralCrossRefGoogle Scholar
  114. 114.
    Sokya M. Substance misuse, psychiatric disorder and violent and disturbed behaviour. Br J Psychiatry. 2000;172:345–50.CrossRefGoogle Scholar
  115. 115.
    Dellazizzo L, Potvin S, Beaudoin M, Luigi M, et al. Cannabis use and violence in patients with severe mental illnesses: a meta-analytic investigation. Psychiatry Res. 2019;274:42–8.PubMedCrossRefGoogle Scholar
  116. 116.
    Volavka J, Citrome L. Heterogeneity of violence in schizophrenia and implications for long-term treatment. Int J Clin Pract. 2008;62(8):1237–45.CrossRefPubMedGoogle Scholar
  117. 117.
    Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry. 2010;22(2):191–201.PubMedCrossRefGoogle Scholar
  118. 118.
    Perry AE, Woodhouse R, Neilson M, et al. Are non-pharmacological intervention effective in reducing drug use and criminality? A systematic and meta-analytical review with an economic appraisal of these interventions. Int J Environ Res Public Health. 2016;13:966.PubMedCentralCrossRefGoogle Scholar
  119. 119.
    Vanderloo MJ, Butters RP. Treating offenders with mental illness: a review of the literature. Utah Criminal Justice Center, University of Utah; 2012.Google Scholar
  120. 120.
    Stevens H, Agerbo E, Dean K, et al. Reduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial. J Clin Psychiatry. 2013;74(5):e439–44.PubMedCrossRefGoogle Scholar
  121. 121.
    Walsh E, Gilvarry C, Samele C, et al. Reducing violence in severe mental illness: randomized controlled trial of intensive case management compared with standard care. BMJ. 2001;323:1–5.CrossRefGoogle Scholar
  122. 122.
    Wilson D, Tien G, Eaves D. Increasing the community tenure of mentally disordered offenders: an assertive case management program. Int J Law Psychiatry. 1995;18:61–9.PubMedCrossRefGoogle Scholar
  123. 123.
    Morrissey J, Meyer P, Cuddeback G. Extending assertive community treatment to criminal justice settings: origins, current evidence, and future directions. Community Ment Health J. 2007;43(5):527–44.PubMedCrossRefGoogle Scholar
  124. 124.
    Tyrer P, Duggan C, Cooper S, Crawford M, et al. The successes and failures of the DSPD experiment: the assessment and management of severe personality disorder. Med Sci Law. 2010;50:9.CrossRefGoogle Scholar
  125. 125.
    Tew J, Dixon L, Harkins L, Bennett A. Investigating changes in anger and aggression in offenders with high levels of psychopathic traits attending the Chromis violence reduction programme. Crim Behav Ment Health. 2012;22:191–201.PubMedCrossRefGoogle Scholar
  126. 126.
    Braham L, Jones D, Hollin C. The Violent Offender Treatment Program (VOTP): development of a treatment program for violent patients in a high security psychiatric hospital. Int J Forensic Ment Health. 2008;7:157–72.CrossRefGoogle Scholar
  127. 127.
    Swartz MS, Bhattacharya S, et al. Involuntary outpatient commitment and the elusive pursuit of violence prevention: a view from the United States. Can J Psychiatry. 2017;62(2):102–8.PubMedCrossRefGoogle Scholar
  128. 128.
    Scott DA, McGilloway S, et al. Effectiveness of criminal justice liaison and diversion services for offenders with mental disorders: a review. Psychiatr Serv. 2013;64(9):843–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Antonio Vita
    • 1
    • 2
    Email author
  • Valentina Stanga
    • 1
  • Anna Ceraso
    • 2
  • Giacomo Deste
    • 1
  • Stefano Barlati
    • 1
    • 2
  1. 1.Department of Mental Health and Addiction ServicesASST Spedali Civili of BresciaBresciaItaly
  2. 2.Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly

Personalised recommendations