Violence and Risk Assessment and Serial Homicide The objective of this study is to examine violence risk assessment and the type of tools and their effectiveness for determining violent reoffenders. Lurigio and Harris (2009) reports in the work entitled "Mental Illness, Violence, and Risk Assessment: An Evidence-Based Review" that the link that has been presumed "between violence and mental illness has long been an ongoing subject of investigation." (2009) The question is posed as to whether those who are mentally ill are more likely "than those without mental illness to commit violent crimes?" (Lurigio and Harris, 2009) As well the question is asked whether mental and criminal justice professionals accurately assess the likelihood of violence?" (Lurigio and Harris, 2009) It is reported that mentally ill individuals with illnesses including schizophrenia, major depression, and bipolar disorder have been historically shunned due to "in part because of the stereotype that they are dangerous." (Lurigio and Harris, 2009)

I. Swanson (1994)

Over the past twenty years, there have been quite a few epidemiological studies that have conducted an examination of the relationship that exists between mental illness and violence. It was found in Swanson 1994 that individuals with mental illness were "more than twice as likely to be involved in assaultive acts as people with no such illness. However, the study found that this difference could be explained mostly by the presence of co-occurring substance use disorders." (Lurigio and Harris, 2009)

II. Co-occurring Mental Illness and Substance Use Disorders

The findings state specifically that individuals with "substance use disorders were more than twice as likely to be involved in assaultive acts that people with only mental illness, and those with both mental illness and substance use disorders were the most likely group to be involved in assaultive acts." (Lurigio and Harris, 2009) In fact, study findings demonstrated that severe mental illness alone "was unrelated to violence. However, people with co-occurring mental illness and substance use disorders were more likely to report violent acts than people with substance use disorders alone." (Lurigio and Harris, 2009) Also increasing the risk of violence among individuals with mental illness were contextual factors, clinical factors and historical factors. In yet another study, findings state that individuals with mental illness with no other risk factors for violence "were no more likely to engage in assaultive acts than members of the general population." (Lurigio and Harris, 2009) In another similar study, findings report "symptoms such as paranoid delusions and command hallucinations -- and not diagnoses per se, predicted violence among people with mental illness." (Lurigio and Harris, 2009)

III. Limited Research on Prediction of Risk of Future Violence

The work of Monahan and Steadman (2006) entitled "Violence Risk Assessment: A Quarter Century of Research" reports the observation of Halleck (1967) in the work entitled 'Psychiatry and the Dilemmas of Crime" stating:

"Research in the area of dangerous behavior (other than generalizations from case materials) is practically nonexistent. Predictive studies which have examined the probability of recidivism have not focused on the issue of dangerousness. If the psychiatrist or any other behavioral scientist were asked to show proof of his predictive skills, objective data could not be offered." (Monahan and Steadman, 2006)

Dangerousness as a concept was introduced into civil commitment statutes as the sole basis for commitment in 1972 defining dangerousness as "a high probability of inflicting imminent substantial physical harm based on a recent explicit act." (Monahan and Steadman, 2006) However, in 1974, the American Psychiatric Association stated conclusions that "psychiatric expertise in the prediction of 'dangerousness' is not established and clinicians should avoid 'conclusory' judgments in this regard." (Monahan and Steadman, 2006)

IV. Barefoot (1978)

Thomas Barefoot was convicted of the capital murder of a police officer in 1978, and at the sentencing hearing the jury considered whether the conduct that has caused the death of the deceased "was committed deliberately and with reasonable expectation that the death of the deceased or another would results" and the question of whether "there is a probability that the defendant would commit criminal acts of violence that would constitute a continuing threat to society." (Monahan and Steadman, 2006) The jury answered affirmatively to both questions requiring that the death penalty be imposed. However, when considered by the Supreme Court on the constitutionality of clinical predictions of violence for the basis of execution, Justice White argued "In Jurek, seven Justices rejected the claim that it was impossible to predict future behavior and that dangerousness was therefore...

1984 U.S. Supreme Court Decision
In a case that followed in 1984, the U.S. Supreme Court stated findings "despite research showing low accuracy rates, as a matter of clinical risk prediction is an acceptable means of assessing dangerousness." (Monahan and Steadman, 2006) This decision determined the status quo until the present day in the U.S. judicial system. It is reported that the American Psychiatric Association's (1983) model state law on civil commitment "included the involuntary hospitalization of people with mental disorders who are "likely to cause harm to others." The guidelines for involuntary civil commitment of the National Center for State Courts (1986) stated that there should be "close attention…paid to predictions of future behavior, especially predictions of violence and assessments of dangerousness." (Monahan and Steadman, 2006) Complicating the situation is the clinician who admits that there is "limited competence to offer estimates of the future" and yet these professionals are legally mandated to do just that. It is reported that the professional consensus is "that predictions of future dangerousness will remain a significant element in legal decisions to restrict the liberty of individuals with mental disorders." (Monahan and Steadman, 2006)

Constitutional challenges to risk assessment have been rejected by the Supreme Court. The legal questions posed of violence prediction are reported to be framed in tort law with Tarasoff v. Regents of the University of California (1976) being the landmark case in this area of the study of law in which the California Supreme Court held that "psychotherapists who know or should know of their patient's likelihood to inflict injury on identifiable third parties have an obligation to take reasonable steps to protect the potential victim…" (Monahan and Steadman, 2006) Only a few state courts have rejected this ruling and other states have limited the scope of this ruling with the majority of courts reported to have "accepted the essence of the 'duty to protect' and several have even expanded that duty to include nonidentifiable victims. (Monahan and Steadman, 2006) It is reported that a legal issue that has not been resolved is the "…development of professional standards for institutionalizing a potentially violent person or releasing that person from an institution . Liability, rather than constitutionality, is the concern that motivates interest in the accurate prediction of violence in the mid-1990s." (Monahan and Steadman, 2006)

VI. Forensic Psychiatric Perspective

The work of Knoll (2006) entitled: Serial Murder: A Forensic Psychiatric Perspective" reports that there have been "over the past several decades…a number of different psychosocial theories put forth on the etiology of serial murder." (Knoll, 2006) Experienced investigators have posited that the behavior might be the result of a "deadly convergence of: (1) early childhood attachment disruptions; (2) psychopathy; and (3) early traumatorgenic abuse. (Knoll, 2006) However, the evidence on child abuse is conflicting in nature in the development of serial murderers. A study of 36 serial murderers by the FBI indicated that many of the individuals "had a history of childhood sexual abuse, and 74% reported a history of psychological abuse that typically involved humiliation." (Knoll, 2006)

It is reported that forensic assessments of suspected serial murderers should be conducted by individuals with experience in the evaluation of psychopathic and serial sexual offenders. The following list is reported to contain traits, characteristics, and behaviors that were frequently found in the backgrounds of perpetrators of sexual homicides.

(1) Childhood abuse;

(2) Inappropriate maternal (sexual) conduct;

(3) Pathological lying and manipulation;

(4) Sadistic fantasy with a compulsion to act;

(5) Animal cruelty particularly against cats;

(6) Need to control and dominate others;

(7) Repetitive fire setting;

(8) Voyeurism, fetishism, and (sexual) burglary;

(9) Unprovoked attacks on females associated with generalized misogynous emotions; and (10) Evidence of ritualistic (signature) behavior. (Knoll, 2006)

VII. Actuarial Risk Assessment Models v. Clinical Risk Assessment Models

The work of Sreenivasan, et al. (2000) entitled "Actuarial Risk Assessment Models: A Review of Critical Issues Related to Violence and Sex-offender Recidivism Assessments" reports that risk assessment of violence and sex offender recidivism have been dichotomized by several prominent researchers as the 'clinical approach' versus the 'actuarial method'." Those who support the actuarial approach are reported to have "…long argued that clinical judgment is bereft of accuracy, and produces many more false positives (i.e. incorrect identification of individuals as violent) than the actuarial model. Their argument is that clinical judgment cannot be used to augment predictions based upon actuarial instruments as such an approach leads to the compromise of accuracy." (Sreenivasan, et al., 2000) Stated as one basis to support the proposition for a sole actuarial approach "are older studies which demonstrated that clinician -based outcomes were less accurate…