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Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics

Pickard, Hannaa; Fazel, Seenab

Current Opinion in Psychiatry: July 2013 - Volume 26 - Issue 4 - p 349–354
doi: 10.1097/YCO.0b013e328361e798
ADDICTIVE DISORDERS: Edited by John B. Saunders and Linda B. Cottler

Purpose of review To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection.

Recent findings Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending.

Summary Improved treatment for substance abuse in forensic psychiatric patients and other mentally disordered offenders together with the offer of monitored abstinence as a condition of leave or discharge could be usefully considered as a means of reducing and managing risk. This may improve patient care by addressing mental health needs and increasing opportunity and likelihood of successful re-integration into the community and better life prospects; protect the public by reducing risk of re-offending and offering real time monitoring and potential intervention when risk is heightened; and help forensic psychiatrists strike a balance between patient care and public protection, potentially alleviating some of the difficulty and anxiety that decisions to grant leave or discharge can create.

aDepartment of Philosophy, Oxford Centre for Neuroethics, University of Oxford

bDepartment of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK

Correspondence to Dr Hanna Pickard, Oxford Centre for Neuroethics, Suite 8, Littlegate House, 16/17 St Ebbe's Street, Oxford OX1 1PT, UK. Tel: +44 1865 286 888; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins