Characteristics of psychiatric patients who engage in assaultive or other fear-inducing behaviors.

The hospital records of 1687 psychiatric patients were rated for the presence of assaultive or other fear-inducing behaviors associated with the reasons for their hospital admissions. Data analyses indicated that significant associations existed between these behaviors and sex, race/ethnicity, diagnosis, previous admissions, referral source for hospitalization, legal status at admission, and legal status at discharge. No associations were found for age, education, marital status, employment status, number of days hospitalized during the index hospitalization, and referral at discharge. A comparison of these results with the results of studies by other investigators led to the conclusion that clinical variables appear to have a more consistent relation to violent behavior than demographic variables. Future research examining for the correlates of violent behavior in psychiatric patients may be more productive by focusing on the type and degree of patients' psychopathologies rather than on patients' demographic characteristics.

Effects of fiscal retrenchment on public mental health services for the chronic mentally ill.

In reviewing the public mental health services of 11 California counties during a period of fiscal retrenchment, we found several common trends: a greater focus on the severely mentally disabled; an increase in utilization of hospital-based care, residential treatment, day treatment, and case management services; and a decrease in the capacity of traditional outpatient services. Although the severely mentally disabled are receiving a higher priority for service, the findings imply that these service systems continue to inadequately address the need for long-term maintenance and supportive services to this population.

Violent or fear-inducing behavior associated with hospital admission.

Recent studies indicate that the incidence of violent or fear-inducing behavior among the mentally ill may be higher than once thought. In this study, medical record admission notes for 1,687 psychiatric patients over a four-year period were examined for indications that the patients had engaged in violent or fear-inducing behavior just prior to hospital admission. This and other studies suggest that the frequency of violent or fear-inducing behavior associated with psychiatric admissions may have stabilized in recent years. The authors also found a significantly higher level of hospital readmissions for violent patients than for other patients. As a result, they caution against assuming that the rate of violent behavior among hospital admissions accurately reflects the prevalence of violent behavior among the general population of the mentally ill.