Henry J. Steadman – författare

The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians'' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work.

Rethinking Risk Assessment tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.

The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians'' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work.

In courts across the country, judges depend on mental health experts to determine whether mentally disordered people are dangerous. But experts' ability to predict violence is severely limited, and they are wrong as often as they are right. This study reviews two decades of research on mental disorder and offers new empirical and theoretical work that will pave the way for more accurate predictions of violent behavior."Essential for all those who are interested in the study of risk assessment of violence. It is particularly important for the researcher in this area. . . . For the clinician who must make violence assessments it is important reading as well."—Stewart Levine, Bulletin of the American Academy of Psychiatry and the Law

In its narrowest sense, "mentally disordered offender" refers to the approximately twenty thousand persons per year in the United States who are institutionalized as not guilty by reason of insanity, incompetent to stand trial, and mentally disordered sex offenders, as well as those prisoners transferred to mental hospitals. The real importance of mentally disordered offenders, however, may not lie in this figure. Rather, it may reside in the symbolic role that mentally disordered offenders play for the rest of the legal system. The 3,140 persons residing in state institutions on an average day in 1978 as not guilty by reason of insanity (see Chapter 4), for example, are surely worthy of concern in their own right. But they represent only 1% of the 307,276 persons residing in state and federal prisons in the same period (U. S. Dept. of Justice, 1981). From a purely numeric point of view, the insanity defense truly is "much ado about little" (Pasewark & Pasewark, 1982). The central importance of understanding these persons, however, is that they serve a symbolic function in justifying the imprisonment of the other 99%. The insanity defense, as Stone (1975) has noted, is "the exception that proves the rule. " By exculpating a relatively few people from being criminally responsible for their behavior, the law inculpates all other law violators as liable for social sanction.

In its narrowest sense, "mentally disordered offender" refers to the approximately twenty thousand persons per year in the United States who are institutionalized as not guilty by reason of insanity, incompetent to stand trial, and mentally disordered sex offenders, as well as those prisoners transferred to mental hospitals. The real importance of mentally disordered offenders, however, may not lie in this figure. Rather, it may reside in the symbolic role that mentally disordered offenders play for the rest of the legal system. The 3,140 persons residing in state institutions on an average day in 1978 as not guilty by reason of insanity (see Chapter 4), for example, are surely worthy of concern in their own right. But they represent only 1% of the 307,276 persons residing in state and federal prisons in the same period (U. S. Dept. of Justice, 1981). From a purely numeric point of view, the insanity defense truly is "much ado about little" (Pasewark & Pasewark, 1982). The central importance of understanding these persons, however, is that they serve a symbolic function in justifying the imprisonment of the other 99%. The insanity defense, as Stone (1975) has noted, is "the exception that proves the rule. " By exculpating a relatively few people from being criminally responsible for their behavior, the law inculpates all other law violators as liable for social sanction.