Walsh and colleagues identified 708 patients aged between 18 and 65 with established psychotic illness in four inner city mental health services. Over a two-year period, 353 patients received intensive case management and 355 patients received standard care. Physical assault during the study was measured by interviews with patients and case managers and examination of case notes.
During the two years of the trial, 80 (23%) of the intensive case management group and 78 (22%) of the standard care group committed assault, representing no significant difference. Risk factors for violence included a history of violence, drug misuse, younger age, victimisation, and learning difficulties. Even after taking these factors into account, no evidence that intensive case management reduced the level of violent behaviour was found.
Legislation for compulsory community treatment in England and Wales has recently been proposed in a government white paper, say the authors. Future research should address the question of whether such treatment combined with psychosocial support can be developed. These need to be effective in reducing violence in a core group of mentally disordered people, they conclude.
Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care BMJ Volume 323, pp 1093-6
Editorial: reducing violence in severe mental illness BMJ Volume 323, pp 1080-81