Aggression, Violence and Psychiatry

Aggression and violence as social problems and psychiatry interrelate in a complicated way. On the one hand, major mental disorders,are risk factors for general and violent offending. On the other hand, mentally disordered individuals are frequently victimized themselves, and at least in the past, patients of psychiatric hospitals frequently experienced neglect, suppression and violent treatment practices. The paper discusses why in closed institutions repression tends to become an end in itself and how that may be averted. In fact, psychiatric hospitals fulfill a repressive function and regularly admit patients committed involuntarily due to them posing a risk to others. In the last 20 years, it was intensively debated if psychiatric reforms and deinstitutionalization have gone too far, thus increasing individuals' risk to get off track, to offend and end up in correctional or forensic psychiatric institutions. It needs to be acknowledged that general psychiatric institutions have a repressive and risk preventing function which cannot be delegated to forensic hospitals. But Germany's general psychiatric departments nowadays often lack the staff and facilities to meet this mission. Assertive community treatment may be considered a promising approach to support patients' coping and treatment adherence outside institutions and to reduce the frequency of crisis-laden involuntary hospital admissions.