Faculty Bibliography

BACKGROUND: The usual modes of incarceration have not been found to curb violence significantly, even while in custody. A jail-based programme called the Resolve to Stop the Violence Project (RSVP) was created with the hypothesis that immersing men with a history of serious, recent and often multiple violent crimes in an intensive, multi-modal in-house 'culture' would serve as a possible first step to preventing further violence. METHODS: Two years of incident reports were reviewed for the programme dorm and a regular dorm, both typically serving an average of 56 male inmates of similar composition, for historic and between-dorm comparisons. RESULTS: During the year before RSVP began, there were 24 violent incidents serious enough to have constituted felonies had they occurred in the community (roughly three per month) in the 62-bed dorm. During the first month RSVP was in effect there was one such incident; and for the following 12 months, there were none. During that same year, the control dorm that still followed traditional jail practices had 28 violent incidents. CONCLUSIONS: Correctional efforts may improve with the transformation of subcultures into therapeutic communities that facilitate the practice of prosocial skills over attitudes and mores that engender violence

BACKGROUND: The usual modes of incarceration have not been found to curb violent crimes significantly. A jail-based programme called the Resolve to Stop the Violence Project (RSVP) was created with the hypothesis that exposing men with a history of serious, recent and often multiple violent crimes to a certain specifiable set of social, cultural and psychological conditions would reduce the frequency and severity of their violent behaviour. METHODS: Court and criminal records for 1 year following release were reviewed for 101 inmates who had spent 8 weeks or more in the programme and for the same number of those who had spent 8 weeks or more in regular custody. RESULTS: Inmates who participated in RSVP had lower rearrest rates for violent crimes (-46.3 percent, p < 0.05) and spent less time in custody (-42.6 percent, p < 0.05). The decline in violent re-arrests increased with greater lengths of stay (-53.1 percent, p < 0.05 for 12 weeks or more; -82.6 percent, p < 0.05 for 16 weeks or more). CONCLUSIONS: Multilevel, comprehensive prevention approaches that: emphasize making available to violent individuals the kinds of tools they need in order to develop non-violent skills and reality-based sources of self-esteem; increase their capacity to experience feelings of empathy and remorse; and provide opportunities to take responsibility and amend the injuries they have inflicted on others and on the whole community, may play an important role in reducing the cycle of violent crime

Prisons were supposedly created for the purpose of the tertiary prevention of violence (i.e., reducing the frequency and severity of future violence on the part of people who have already become violent). However, there is much evidence that this method of attempting to prevent violence is often, though not always, either ineffectual or counterproductive, in which case it is either a waste of money or actually exacerbates the problem it was ostensibly intended to solve. This article reviews evidence concerning those questions including an analysis of the effect of punishment (one of the main purposes of prisons) on violent behavior. Punishment--the infliction of pain--will be distinguished from restraint (incapacitation, separation from the community). Successful examples of violence prevention in unconventional prison programs, emphasizing therapy and education rather than punishment, and restorative rather than retributive justice, will be summarized, together with evidence that these programs reduce re-incarceration rates so substantially that they actually save the taxpayers more money than they cost, in addition to enhancing the safety of the general public. The position is taken that traditional prisons provoke more violence than they prevent and are so fundamentally flawed that they cannot be reformed; we argue that they should instead be abolished and replaced by 'anti-prisons,' that is, locked, secure residential colleges, therapeutic communities, and centers for human development. Prisons will come to be seen as a well-meaning experiment that failed, rather like the use of leeches in medicine

Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long-term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short-term emergency treatment of a violent crisis and the long-term treatment of those who are chronically and repetitively violent, and these differences are also summarized here

The public mental hospital system was created in part because many mentally ill people were being held in prisons and jails. Support for those hospitals waned over time, however, and by the time they had degenerated into "snake pits" a consensus was reached to close them down. Unfortunately, they were not replaced with adequate community mental health resources, so as the hospitals have emptied, the prisons and jails have filled, partly with the mentally ill. That is the destructive reason for the growth of prison psychiatry in this country: the prison has become the last mental hospital. The constructive one has been a new emphasis on bringing psychiatric treatment to a previously neglected population: people who have committed serious violence, whether because of Axis I mental illnesses or Axis II character disorders. Unfortunately, four inter-related, mutually reinforcing nationwide trends threaten to reinforce that destructive development and vitiate the constructive one.