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The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration.

ABSTRACT: BACKGROUND:Outpatient civil commitment (OCC) provisions, community treatment orders (CTOs) in Australia and Commonwealth nations, are part of mental health law worldwide. This study considers whether and by what means OCC provides statutorily required "needed-treatment" addressing two aspects of its legal mandate to protect the safety of self (exclusive of deliberate-self-harm) and others. METHOD:Over a 12.4-year period, records of hospitalized-psychiatric-patients, 11,424 with CTO-assignment and 16,161 without CTO-assignment were linked to police-records. Imminent-safety-threats included perpetrations and victimizations by homicides, rapes, assaults/abductions, and robberies. "Need for treatment" determinations were validated independently by Health of the Nations Scale (HoNOS) severity-score-profiles. Logistic regressions, with propensity-score- adjustment and control for 46 potential confounding-factors, were used to evaluate the association of CTO-assignment with occurrence-risk of perpetrations and victimizations. RESULTS:CTO-assignment was associated with reduced safety-risk: 17% in initial-perpetrations, 11% in initial-victimizations, and 22% for repeat-perpetrations. Each ten-community-treatment-days in interaction with CTO-assignment was associated with a 3.4% reduced-perpetration-risk. CTO-initiated-re-hospitalization was associated with a 13% reduced-initial-perpetration-risk, a 17% reduced-initial-victimization-risk, and a 22% reduced-repeat-victimization-risk. All risk-estimates appear to be the unique contributions of the CTO, CTO-initiated-re-hospitalization, or the provision of ten-community-treatment-days-i.e. after accounting for the influence of prior crimes and victimizations, ethnic-bias, neighborhood disadvantage and other between-group differences in the analysis. CONCLUSIONS:CTO assignment's association with reduced criminal-victimization and perpetration-risk, in conjunction with requiring participation in needed-treatment via re-hospitalization and community-service, adds support to the conclusion that OCC is to some extent fulfilling its legal objectives related to protecting safety of self (exclusive of deliberate-self-harm), and others.

SUBMITTER: Segal SP

PROVIDER: S-EPMC7202380 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration.

Segal Steven P SP Rimes Lachlan L Hayes Stephania L SL

European psychiatry : the journal of the Association of European Psychiatrists 20190114

<h4>Background</h4>Outpatient civil commitment (OCC) provisions, community treatment orders (CTOs) in Australia and Commonwealth nations, are part of mental health law worldwide. This study considers whether and by what means OCC provides statutorily required "needed-treatment" addressing two aspects of its legal mandate to protect the safety of self (exclusive of deliberate-self-harm) and others.<h4>Method</h4>Over a 12.4-year period, records of hospitalized-psychiatric-patients, 11,424 with CT ...[more]

PMID: 30654319

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Project description:Evidence on the prevalence of sexual aggression among college students is primarily based on studies from Western countries. In Chile, a South American country strongly influenced by the Catholic Church, little research on sexual aggression among college students is available. Therefore, the purpose of the present study was to examine the prevalence of sexual aggression victimization and perpetration since the age of 14 (the legal age of consent) in a sample of male and female students aged between 18 and 29 years from five Chilean universities (N = 1135), to consider possible gender differences, and to study the extent to which alcohol was involved in the reported incidents of perpetration and victimization. Sexual aggression victimization and perpetration was measured with a Chilean Spanish version of the Sexual Aggression and Victimization Scale (SAV-S), which includes three coercive strategies (use or threat of physical force, exploitation of an incapacitated state, and verbal pressure), three victim-perpetrator constellations (current or former partners, friends/acquaintances, and strangers), and four sexual acts (sexual touch, attempted sexual intercourse, completed sexual intercourse, and other sexual acts, such as oral sex). Overall, 51.9% of women and 48.0% of men reported at least one incident of sexual victimization, and 26.8% of men and 16.5% of women reported at least one incident of sexual aggression perpetration since the age of 14. For victimization, only few gender differences were found, but significantly more men than women reported sexual aggression perpetration. A large proportion of perpetrators also reported victimization experiences. Regarding victim-perpetrator relationship, sexual aggression victimization and perpetration were more common between persons who knew each other than between strangers. Alcohol use by the perpetrator, victim, or both was involved in many incidents of sexual aggression victimization and perpetration, particularly among strangers. The present data are the first to provide a systematic and detailed picture of sexual aggression among college students in Chile, including victimization and perpetration reports by both men and women and confirming the critical role of alcohol established in past research from Western countries.

Project description:BACKGROUND:Intimate partner violence (IPV) is prevalent in high- as well as low-income contexts. It results in a substantial public health burden and significant negative socioeconomic and health outcomes throughout the life-course. However, limited knowledge exists about IPV during early adolescence. This period is critical during the transition to adulthood for at least two reasons: it is when the majority of adolescents in low-income countries first encounter dating, sexuality and partnerships, often with older adolescents or adults, and it is also the period when lifelong patterns of violence and norms about acceptable IPV are formed. The current study is one of the first to measure IPV prevalence among young adolescents in a low-income setting, examine the potential etiology, and investigate relationships with gender ideology, poverty, mental health and childhood adversity. METHODS:We surveyed 2,089 adolescents aged 10-16 in Malawi using standardized instruments. We estimated the prevalence of IPV, and use multivariate logistic regression to test potential correlates. RESULTS:More than a quarter (27%) of ever-partnered adolescents in Malawi report being victimized. A substantial proportion of both male and female adolescents (15%) report committing violence against their partner. Girls were more likely than boys to report being a victim of sexual IPV (24% versus 8%), and boys more likely to perpetrate such (9% versus 1%). Almost 10% of the sample had both committed and been a victim of IPV. Cumulative childhood adversity (e.g., physical abuse, witnessing domestic violence) was a consistent and strong correlate of IPV victimization (adjusted odds ratio (aOR) 1.30) and of perpetration (aOR 1.35). Depression and PTSD were likewise associated with IPV victimization in the overall sample. Notably, gender ideology was not predictive of either victimization or perpetration, even among boys. CONCLUSIONS:IPV is common for both male and female young Malawian adolescents, and includes both victimization and perpetration. IPV compounds other adversities experienced by adolescents in this low-income setting, and it is rarely alleviated through help from the health system or other formal support. These findings underscore the need to intervene early when interventions can still break destructive pathways and help foster healthier relationships. This focus on early adolescence is particularly critical in low-income countries given the early onset and rapid pace of the transition to adulthood, with sexual activity, dating and partnership thus being common already in young adolescence. Promising interventions would be those that reduce violence against or around children, as well as those that reduce the impacts of such trauma on mental health during adolescence.

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The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration.

Publications

The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration.

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