Pinals Debra A
Law and Psychiatry Program,Department of Psychiatry,University of Massachusetts Medical School,Worcester,Massachusetts,USA.
CNS Spectr. 2015 Jun;20(3):241-9. doi: 10.1017/S1092852915000164. Epub 2015 Apr 27.
Criminal conduct is not always violent, and violence does not always lead to criminal charges. Moreover, crime and violence have multifaceted etiologies. Most violence in society is not attributable to mental illness. Where there is a small relationship between violence and mental illness, the risk of violence increases for individuals with substance use histories. Underlying trauma can also play a role. Antisocial attitudes, behaviors, and peer groups further increase the risk that individuals, including those with mental illness, will find themselves at risk of criminal recidivism. Criminal histories among public mental health populations, and mental health and substance use disorders among criminal populations are each higher than general population comparisons. Care within behavioral health settings should therefore target decreased criminal recidivism and decreased violence as part of recovery for those individuals at risk, using trauma-informed approaches and peer supports. Interventions that show promise bring criminal justice and behavioral health systems together, and include police-based diversion, specialty courts, court-based alternatives to incarceration, and coordinated re-entry programs. This article reviews these options along with specific risk management strategies, such as using risk, needs, and responsivity factors as a means of improving overall outcomes for persons with mental illness, while minimizing their risk of further criminalization and victimization.
犯罪行为并不总是暴力的，暴力行为也并不总是会导致刑事指控。此外，犯罪和暴力有着多方面的病因。社会中的大多数暴力行为并非由精神疾病所致。在暴力与精神疾病之间存在微弱关联的情况下，有药物使用史的个体实施暴力的风险会增加。潜在的创伤也可能起作用。反社会态度、行为以及同龄人群体进一步增加了包括患有精神疾病者在内的个体再次犯罪的风险。公共心理健康人群中的犯罪史以及犯罪人群中的心理健康和药物使用障碍均高于普通人群。因此，行为健康环境中的护理应以降低再次犯罪率和减少暴力行为为目标，作为对那些有风险的个体进行康复治疗的一部分，采用创伤知情方法和同伴支持。有前景的干预措施将刑事司法系统和行为健康系统整合在一起，包括基于警察的分流、专门法庭、基于法庭的替代监禁措施以及协调的重新融入计划。本文回顾了这些选项以及具体的风险管理策略，例如将风险、需求和反应性因素作为改善精神疾病患者总体结局的一种手段，同时将他们进一步被定罪和受害的风险降至最低。
