TOPIC:

AN EXAMINATION ON THE DIFFERENT MENTAL ILLNESSES AS A

CONTRIBUTING FACTOR IN HOMICIDE

By

Sherise Nundhkumar
STUDENT NUMBER: 62761552

Submitted in Partial fulfilment of the requirements for the degree of

Selected Crimes and Transgressions (FOR4804)

In The Bachelor of Arts Honours in Forensic Science and Technology School of Criminal
Justice UNIVERSITY OF SOUTH AFRICA

SUPERVISOR: Professor Juanida Horne

ASSIGNMENT: 03
Year: 2023
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Table of Contents
1. Section 1: Introduction .................................................................................................................... 2

2. Section 2: Literature review ............................................................................................................ 3

2.1 Common mental illnesses associated with violent behaviour ................................................... 3
2.1.1 Antisocial Personality Disorder (ASPD) ....................................................................................... 4
2.1.2 Borderline Personality Disorder (BPD) ......................................................................................... 5
2.1.3 Schizophrenia .................................................................................................................................. 6
2.1.4 Bipolar Disorder ............................................................................................................................... 6
2.2 Risk factors and mitigating elements in the link between mental illness and violent
behaviour ......................................................................................................................................................... 7
2.2.1 Substance abuse......................................................................................................................... 7
2.2.2 Lack of treatment......................................................................................................................... 7
2.2.3 History of violent behaviour ....................................................................................................... 8
2.2.4 Co-occurring disorders ............................................................................................................... 8
2.2.5 Social support and isolation ....................................................................................................... 8
2.2.6 Access to weapons ..................................................................................................................... 9
2.3 Treatment approaches .................................................................................................................... 9
2.3.1 Medication ...................................................................................................................................... 10
2.3.2 Psychotherapy ............................................................................................................................... 12
2.3.3 Anger Management Training ....................................................................................................... 13
2.3.4 Social Skills Training ..................................................................................................................... 15
2.3.5 Crisis Intervention and Safety Planning ..................................................................................... 16
2.3.6 Community Support and Rehabilitation ...................................................................................... 17
2.3.7 Electroconvulsive therapy (ECT) ................................................................................................. 18
2.3.8 Transcranial magnetic stimulation (TMS) .............................................................................. 19
2.4 Different impact among individuals with mental illness ............................................................ 21
2.4.1 Medication .................................................................................................................................. 21
2.4.2 Therapy ....................................................................................................................................... 23
2.5 The severity of the mental illness affect the risk of violent behaviour .................................... 25
2.6 The role of family and community support ................................................................................. 26
2.7 Access to mental health care affect the risk of violent behaviour among individuals with
mental illness ................................................................................................................................................ 28

3. Section 3: Conclusion and recommendation ............................................................................ 29

3.1 Findings ................................................................................................................................................... 29
3.2 Recommendations................................................................................................................................. 32
3.3 Limitations ............................................................................................................................................... 33

4. List of Reference ............................................................................................................................ 34

5. Declaration ...................................................................................................................................... 42

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1. Section 1: Introduction

'Untreated profound mental illness is particularly significant in cases of homicide,'

(Ghiasi, Azhar & Singh, 2023) as it significantly impacts the relationship between
mental health and violence. Mental illness, including schizophrenia and bipolar
disorder, can lead to violent acts if untreated or inadequately managed. However,
most individuals with mental illness are not violent, and homicides often involve
multiple factors (“Mental illness and violence”, 2019). Understanding the influence of
mental illness and other health conditions on violent behaviour is crucial for public
safety and mental health treatment (“Mental illness and violence”, 2019). Individuals
with certain illnesses may be more likely to perpetrate violent acts due to their nature
or inadequate management. This issue affects both public safety and mental health
treatment, and understanding the relationship between health conditions and
homicide can aid in identifying individuals at risk and developing effective prevention
and intervention strategies (The Science of Changing Behavioural Health Social
Norms, Sciences Cognitive Board on Behavioural, Behavioural and Social Sciences
and Education & Engineering National Academies of Sciences, 2016). The complex
interaction between mental illness, substance addiction, and other health factors can
increase the risk of violent behaviour, but much remains to be learned about how
these factors interact and how to resolve them (The Science of Changing
Behavioural Health Social Norms, Sciences Cognitive Board on Behavioural,
Behavioural and Social Sciences and Education & Engineering National Academies
of Sciences, 2016). As someone interested in investigating the relationship between
health and violent behaviour and promoting evidence-based approaches to
prevention and treatment, it is essential for the reader to understand my perspective.

Mental illness and aggressive behaviour, including murder, need to be better

understood. This matters for public safety and mental health policies (STUART,
[Sa]). This research may improve mental illness treatment and violent crime
prevention. Current research suggests a complicated association between mental
illness and aggressive behaviour (STUART, [Sa]). Substance addiction, trauma, and
social and environmental variables may also cause aggressive behaviour. It's
important to remember that most people with mental illness aren't violent and that
most killings are committed by those without a diagnosis (STUART, [Sa]). A
sophisticated knowledge of this topic is essential to developing successful violence
prevention and mental health promotion programs.

The relationship between mental illness and violent behaviour, particularly in

homicide cases, is problematic due to the perpetuation of stereotypes and stigma
against people with mental illness, which can have negative effects on their lives and
access to care (Almomen, Alqahtani, Alafghani, Alfaraj, Alkhalifah, Bin Jalalah,
Alsuwailem and Hilal, 2022). As relying solely on identifying and institutionalizing
individuals with mental illness may be ineffective and a violation of individual rights,
misguided policies and practices may be counterproductive (Almomen et al. 2022).

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Failure to resolve this issue may result in significant costs, including increased
isolation and vulnerability, an increased likelihood of violent behaviour, and missed
opportunities to identify and intervene with individuals who pose a risk of causing
injury to themselves or others (Almomen et al. 2022). This issue must be addressed
in order to promote public safety, improve mental health outcomes, and minimize the
harm caused by violent behaviour.

The purpose of this study is to determine the efficacy of medication, psychotherapy,

and other interventions in reducing the risk of violent behaviour in mentally ill patients
(Adeniyi and Puzi, 2021). What effect do various treatment approaches have on the
likelihood that individuals with mental illness will engage in violent behaviour? To
address potential limitations, such as controlling for confounding variables and
ethical considerations, stigmatizing or discriminatory language should be omitted
from the research. Monitoring treatment progress and violent behaviour incidents
can be conducted using a quantitative method, such as a retrospective cohort study
or randomized controlled trial (Adeniyi and Puzi, 2021). In order to acquire a deeper
understanding of the relationship between mental illness and violent behaviour,
qualitative research techniques, such as interviews and focus groups, can be
employed. The purpose of this report is to contribute to a greater comprehension of
the complex relationship between mental illness and violent behaviour and to identify
potential strategies for enhancing public safety and mental health outcomes.

2. Section 2: Literature review

A literature review is an evaluative and all-encompassing synopsis of pre-

existing information pertaining to a certain subject matter or research inquiry
(Smela, Toumi, Świerk, Francois, Biernikiewicz, Clay, & Boyer, 2023). The
process entails a methodical examination, assessment, and integration of
scholarly sources, such as books, papers, and other academic publications,
that are pertinent to the topic under investigation. A literature review serves
the objective of establishing a theoretical framework and backdrop for a
research project, pinpointing deficiencies in current knowledge, and
substantiating the necessity for additional exploration.

2.1 Common mental illnesses associated with violent behaviour

Sopromadze and Tsiskaridze (2018: 106-121) provide a fundamental

comprehension of aggressive conduct in the context of mental health research,
acting as a crucial basis for unravelling the complex connection between mental
health and aggression. Their profound understanding serves as the foundation on
which we travel the intricate landscape of psychological dynamics, with the goal of
unravelling the elements that contribute to or alleviate violent inclinations.

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Jamison (2019: 115-119) brings our attention to a crucial point of convergence: the
junction between bipolar illness and the distressing presence of suicide. By shedding
light on this connection, Jamison not only emphasizes the seriousness of mental
health difficulties but also urges us to confront the intricacies of an illness that go
beyond simple diagnostic categories. This inquiry serves as a perspective from
which we examine the wider scope of mental health, acknowledging the importance
of delving into its intricacies in order to gain a comprehensive understanding.

Directing our attention towards the complex fabric of society, Rivara, Adhia, Lyons,
Massey, Mills, Morgan, Simckes and Rowhani-Rahbar (2019: 1622-1629) present a
comprehensive overview of the impact of violence on health. Their study,
documented in the records of Health Affairs, goes beyond the individual level and
reaches into the public domain. The canvas they portray is not only a collection of
statistics; it serves as a summons to awareness, reminding us of the complex
network linking personal well-being to the overall vitality of society.

Simultaneously, Johnson (2019: 76-88) explores the obscure realm, deciphering the
mystery behind its aggressive nature. Antisocial personality disorder, psychopathy,
and sociopathy are examined closely from a forensic perspective, leading to a
broader understanding of these conditions. Within the Forensic Research &
Criminology International Journal, Johnson initiates a comprehensive investigation,
recognizing the intricate and multifaceted nature of mental health and its
interconnectedness with aggressive conduct.

Together, these academic voices construct a story that goes beyond individual
viewpoints. This analysis combines these elements, creating a thorough
comprehension of the interaction between mental health and violence. As we explore
this subject, we rely on the valuable perspectives of Sopromadze, Tsiskaridze,
Jamison, Rivara, and Johnson. Each of their contributions adds to our collective
understanding of the complex aspects of the human mind and its impact on
behaviour.

2.1.1 Antisocial Personality Disorder (ASPD)

A detailed examination of Antisocial Personality Disorder (ASPD) has been

conducted by Anderson and Kelley (2022: 397), who provide a critical study of ASPD
and its complex association with psychopathy. Their research provides vital insights
into the features and implications of this condition, enhancing our comprehension of
the intricacies within the domain of behavioural disorders.

Robinson, Bitsko, O’Masta, Holbrook, Ko, Barry, Maher, Cerles, Saadeh, MacMillan
and Mahmooth (2022: 1-19) did a comprehensive study and analysis to investigate
the many risk variables associated with attention-deficit/hyperactivity disorder
(ADHD) in children within a wider social framework. This study, which involves

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analysing the impact of Antisocial Personality Disorder (ASPD), highlights the

interdependence of mental health problems within the context of family relationships
and society as a whole. The findings not only contribute to scholarly debate but also
have implications for public health and preventative strategies.

Fernandes (2019) did a cross-generational analysis that predicted a probable

increase in antisocial personality disorder. This study focuses on the need to identify
and intervene early, using a proactive approach to address the possible
development of Antisocial Personality Disorder (ASPD).

For instance, John has consistently shown a pattern of ignoring the rights of others
throughout his teenage years. He often participates in unlawful behaviours, such as
stealing and fraud, without feeling any regret. Notwithstanding the legal
repercussions, he persists in engaging in these actions. John has a consistent
tendency towards impulsive and violent behaviour, frequently resulting in
confrontations and altercations.

2.1.2 Borderline Personality Disorder (BPD)

Bohus, Stoffers-Winterling, Sharp, Krause-Utz, Schmahl and Lieb (2021: 1528-

1540), enhance the comprehension of Borderline Personality Disorder (BPD) with
their extensive summary published in The Lancet. Their research sheds light on
important clinical features of BPD, promoting a detailed understanding of this
complex mental disorder.

Bozzatello, Bellino, Bosia and Rocca (2019: 710) offer useful insights into ways for
detecting and managing Borderline Personality Disorder (BPD) in its early phases,
focusing on early identification and management. Their focus on early diagnosis is in
line with the wider movement in mental health towards preventative and
individualized therapy.

In their publication in Perspectives on Psychological Science, Masland, Victor,

Peters, Fitzpatrick, Dixon-Gordon, Bettis, Navarre and Rizvi (2023: 445-460) argue
for the need to remove the negative social beliefs and attitudes around Borderline
Personality Disorder, in order to reduce the stigma associated with it. This research
serves as both an academic contribution and a strong call to action for societal
change, emphasizing the significance of diminishing the stigma surrounding BPD.

For instance, Sarah encounters tremendous fluctuations in her emotional state. She
experiences a profound dread of being abandoned and encounters difficulties in
establishing and sustaining secure relationships. When experiencing strong
emotional turmoil, Sarah exhibits impulsive acts, such as self-inflicted violence or
engaging in dangerous sexual relationships. These activities are strategies
employed to manage her overpowering emotions.

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2.1.3 Schizophrenia

In their paper in JAMA Psychiatry, McCutcheon, Marques and Howes (2020: 201-
210) provide a comprehensive and enlightening summary of Schizophrenia,
highlighting important aspects of this intricate mental condition. Their input enhances
the scholarly discussion on schizophrenia and its clinical symptoms.

Elvevag and Goldberg (2000) extensively examine the cognitive components of

schizophrenia, offering a meticulous evaluation published in Critical Reviews™ in
Neurobiology. Their research enhances the comprehension of the complex
characteristics of schizophrenia, going beyond its obvious symptoms by specifically
examining cognitive impairment.

Horváth and Mirnics (2015: 22-28) add to the developing understanding of

schizophrenia as a condition characterized by biological pathways in their research
published in Biological Psychiatry. Their investigation into the fundamental biological
pathways provides a molecular viewpoint for comprehending schizophrenia.

For instance, Alex, who has been diagnosed with schizophrenia, sometimes
encounters episodes of paranoid delusions and hallucinations. During these
instances, he may have paranoid delusions, resulting in hostile outbursts as a means
of self-protection. These actions do not represent his typical personality but manifest
during intense episodes of his condition.

2.1.4 Bipolar Disorder

In The Lancet, Grande, Berk, Birmaher and Vieta (2016: 1561-1572) provide an
extensive analysis of Bipolar Disorder, presenting a thorough exploration of several
aspects of the condition. Their study serves as a testament to the progressive
comprehension of bipolar disorder and is a vital asset for doctors and researchers.

Carvalho, Firth and Vieta (2020: 58-66) provide a comprehensive analysis of Bipolar
Disorder in the New England Journal of Medicine, exploring the most recent
advancements in comprehending and managing bipolarity. This paper makes a
valuable contribution to the continuing discourse within the medical community,
providing important information for clinical practices and offering guidance for future
research.

McIntyre, Berk, Brietzke, Goldstein, López-Jaramillo, Kessing, Malhi, Nierenberg,

Rosenblat, Majeed and Vieta (2020: 1841-1856) enhance the existing body of
knowledge on Bipolar Disorders through their publication in The Lancet.
Encompassing several facets of bipolarity, their thorough analysis functions as a vital
reference for scholars, practitioners, and researchers grappling with the intricacies of
bipolar disease.

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For instance, Emily, who has been diagnosed with Bipolar Disorder, experiences
episodes of intense mood fluctuations. During manic periods, she exhibits impulsive
and dangerous actions, such as indulging in extravagant spending or embarking on
big tasks without regard for the repercussions. These outbursts exhibit a stark
contrast to her moments of greater stability.

Individuals exhibit unique manifestations of mental health issues, and real-life

instances necessitate a thorough comprehension of an individual's background,
symptoms, and circumstances. It is essential to engage in mental health
conversations with tact and consideration for the confidentiality of individuals.

2.2 Risk factors and mitigating elements in the link between mental illness and violent
behaviour

Comprehending the complex relationship between mental illness and violent

behaviour is crucial in order to formulate efficacious therapies and preventive
strategies. Although the majority of people with mental disorders do not demonstrate
violent conduct, there are specific risk factors that might heighten the likelihood of
participating in such behaviours. The objective of this study is to examine the key
risk factors associated with violent behaviour in individuals diagnosed with mental
illness, as well as the protective factors that contribute to mitigating these risks.

2.2.1 Substance abuse

In a study done by Whiting, Lichtenstein and Fazel (2021: 150-161), a thorough

examination was carried out, uncovering a strong association between the abuse of
substances and an increased propensity for those with mental diseases to partake in
violent behaviour. In their study, Marr, Webb, Yee and Dean (2024: 130-149),
conducted a comprehensive investigation of the correlation between interpersonal
violence perpetration, the risk of victimization, and drug abuse within the framework
of mental illness. As an illustration, an individual named John, who has been
diagnosed with bipolar illness, frequently engages in alcohol consumption, which
subsequently culminates in a confrontational incident with a neighbour during a
particularly severe episode. In a similar vein, Sarah, who grapples with
schizophrenia, routinely engages in substance addiction, hence exacerbating her
involvement in a violent altercation with police authorities.

2.2.2 Lack of treatment

Corrigan, Druss and Perlick (2014: 37-70) emphasize the importance of mental
disease stigma in hindering the pursuit and participation in mental health treatment,
hence raising the probability of participating in violent behaviour. In their study,
Faccio and Rocelli (2021: 481-487) investigate several strategies employed in the
management of violence within mental health facilities, with a particular focus on the

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importance of effective therapeutic interventions. Specifically, Michael, who was

diagnosed with a severe depressive disorder, encountered social stigma that acted
as a deterrent to seeking assistance from mental health professionals.
Consequently, this led to a progression of interpersonal disputes and instances of
aggression. Emily, who has received a diagnosis of an anxiety illness, has a
documented pattern of engaging in violent behaviour during periods when her
condition was left untreated, with the delay in care being attributed to systemic
deficiencies.

2.2.3 History of violent behaviour

The study by Sariaslan, Arseneault, Larsson, Lichtenstein and Fazel (2020: 359-367)
looked at the relationship between mental health issues and the likelihood of
witnessing or taking part in violent acts. The study by De Brito, Forth, Baskin-
Sommers, Brazil, Kimonis, Pardini, Frick, Blair and Viding (2021: 49) provides
insightful information about the phenomenon of psychopathy, with a focus on the
significance of past violent behaviour as a reliable predictor of potential future violent
tendencies. For instance, Mark, who has been diagnosed with antisocial personality
disorder, possesses a well-documented record of engaging in violent behaviours,
hence heightening the probability of future acts of violence. Rachel, who received a
diagnosis of conduct disorder throughout her teens, had persistent aggressive
behaviour that persisted into her maturity.

2.2.4 Co-occurring disorders

Martinez (2020) explores the phenomenon of co-occurring mental disorders,

highlighting its significance in comprehending the propensity for aggressive
behaviour. The study by Bourgeois, Lecomte, McDuff and Daigneault (2021: 111),
looked at the connection between mental health issues, specifically comorbid
conditions, and their capacity to predict the onset of psychotic disorders in children
who have experienced sexual assault. An illustrative example is Alex, an individual
diagnosed with schizophrenia who had challenges related to drug addiction, hence
increasing the likelihood of engaging in violent episodes. Laura, who received a
diagnosis of post-traumatic stress disorder (PTSD) subsequent to experiencing a
traumatic experience, exhibited the emergence of psychotic symptoms, hence
heightening her vulnerability to engaging in violent conduct.

2.2.5 Social support and isolation

In their study, Yonemoto and Kawashima (2023: 85-100) conducted a thorough

examination of the patterns of requesting assistance during the COVID-19
pandemic, highlighting the significant impact of social support on the psychological
welfare of individuals. The study by Scott, Pitman, Kozhuharova and Lloyd-Evans
(2020: 1-20) provides insightful information on the effects of informal social support
on the psychological health of those who have lost a loved one due to sudden or

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violent causes of death. Daniel, who has received a diagnosis of severe depressive
illness, actively sought comfort and support through social ties, which served as a
mitigating factor against engaging in violent conduct. Maria, who encountered
feelings of isolation following an abrupt bereavement, encountered a heightened
susceptibility to acts of violence, which was alleviated by the implementation of
community-based supporting measures.

2.2.6 Access to weapons

Broyd, Boniface, Parsons, Murphy, and Hafferty (2023: 254-264) conducted a

narrative review examining the correlation between incels, violence, and mental
health issues, with a specific focus on the accessibility of weapons. Anestis and
Daruwala's study (2021: 364), looked into the relationship between attitudes toward
weapons and beliefs about the significance of mental illness in relation to gun
violence. In the context of illustrating a case, it is noteworthy that Chris, who has
been diagnosed with obsessive-compulsive disorder, had a pronounced inclination
towards online groups that endorse and propagate violent content, hence
heightening the associated risks. The individual named Julia, who had received a
diagnosis of bipolar disorder, had guns in a readily accessible manner, which
subsequently resulted in a violent occurrence during a period of heightened manic
symptoms.

Mitigating factors include the provision of therapy, support, and early intervention to
persons with mental illness, which has been found to decrease the likelihood of their
involvement in violent conduct. Numerous studies continuously indicate that the
provision of comprehensive mental health treatment, the establishment of a strong
support system, and the implementation of prompt intervention measures have a
substantial role in reducing the risks connected with violence within this particular
demographic.

This study adds to the existing body of knowledge by providing a more

comprehensive understanding of the many risk variables that lead to the
manifestation of aggressive behaviour in people diagnosed with mental illness.
Through the identification of these determinants and the recognition of the protective
features, policymakers, mental health professionals, and communities may engage
in collaborative efforts to adopt focused treatments that not only improve public
safety but also foster the overall well-being of those with mental illness.

2.3 Treatment approaches

Effective intervention and assistance are vital in mitigating the likelihood of
aggressive conduct in people with psychiatric disorders. The selection of treatment
modalities is contingent upon variables such as the individual's diagnosis, the
intensity of symptoms, and other relevant circumstances. It is crucial to recognize

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that not all people with mental illness have aggressive inclinations, and the majority
do not.

2.3.1 Medication

The study by Morgan, Scanlon, and Van Horn (2020: 237-244) emphasizes the
intricate relationship between criminogenic risk and mental health. This highlights the
necessity of employing sophisticated strategies when dealing with aggressive
conduct in people with mental illness. Comprehending criminogenic risk variables in
depth is crucial for customizing interventions that are effective.

Medication is a highly common kind of treatment for mental illness, providing a

focused strategy to effectively control symptoms. Antipsychotics, mood stabilizers,
and antidepressants are often prescribed drugs that can help alleviate the symptoms
of mental illness, therefore reducing the probability of aggressive conduct. According
to Zhang, Qi, Wen, Hu, Mao, Pan, Zhang, and Fang (2023: 83), identifying risk
factors is crucial for predicting violent behaviour in community patients with severe
mental health issues. Their retrospective analysis of 5277 patients in China provides
unique insights into the particular risk variables linked to aggressive conduct,
enhancing our comprehension of treatment efficacy.

It is important to acknowledge that the efficacy of medicine might differ across

individuals, and the presence of negative effects can present difficulties that impact
an individual's overall well-being. Lawrence, Mcfield, Byrne, Tarver, and Stewart
(2023: 69-79) offer further insight by examining how depression and substance
abuse might result from being exposed to familial violence. Their study presents the
moderation, mediation, and self-medication theory, which elucidates the intricate
relationship between mental health, drug use, and violent conduct.

For example, people diagnosed with disorders such as schizophrenia may be

administered antipsychotic drugs like risperidone or olanzapine. These drugs are
intended to diminish hallucinations and delusions that might potentially lead to
aggressive conduct. Nevertheless, healthcare personnel must meticulously assess
the individual's distinct circumstances, possible adverse reactions, and overall
welfare while providing drugs.

Prescribing medicine should be based on a thorough evaluation of the person's

mental health and a cooperative effort between healthcare providers and the
individual. To improve effectiveness and lower side effects, continuous monitoring
and changes to medication schedules may also be needed. This will ensure a well-
rounded and personalized treatment plan that fits the person's needs.

Take Alex's instance, a 28-year-old man with a schizophrenia diagnosis. Alex has a
documented record of suffering from intense hallucinations and delusions, which

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have led to moments of heightened anxiety and, occasionally, instances of violent

outbursts. The interdisciplinary mental health treatment team, comprising a
psychiatrist, therapist, and social worker, collectively determines to include
medication in his treatment regimen.

After conducting a comprehensive evaluation, Alex's psychiatrist recommends

risperidone, an antipsychotic medicine that is recognized for its efficacy in treating
the symptoms of schizophrenia. The objective is to mitigate the intensity of
hallucinations and delusions, thereby decreasing the probability of Alex exhibiting
aggressive conduct during times of acute distress.

The diagnosis of schizophrenia in Alex has a pivotal role in determining the

treatment options. The therapy team does a thorough evaluation, including the
characteristics and intensity of his symptoms, along with any past instances of
aggressive conduct.

The physician recommends risperidone due to its established effectiveness in

treating the particular symptoms linked to schizophrenia. The selection of medicine is
determined by evaluating the prospective advantages and drawbacks, with the
objective of mitigating the likelihood of aggressive conduct.

The choice to incorporate medicine into Alex's treatment plan is reached through a
collaborative process, which entails the involvement and input of the psychiatrist,
therapist, and social worker. This cooperative method guarantees a comprehensive
comprehension of Alex's requirements and corresponds with the multifaceted aspect
of mental health therapy.

Alex's response to the drug is carefully observed and evaluated over a period of
time. Frequent consultations with the treatment team enable modifications to the
pharmaceutical regimen if necessary. This dynamic approach acknowledges that the
efficacy of medicine might differ across individuals and may necessitate adjustments
based on the individual's changing circumstances.

Although medicine is an essential element of the treatment approach, it is not the

only intervention. Alex also participates in frequent therapy sessions to tackle
underlying difficulties, acquire coping techniques, and improve general well-being. It
is essential to foster social support from both family and friends in order to have a
comprehensive support network.

The treatment approach is customized to address Alex's individualized requirements,

including his exact diagnosis, symptomatology, and personal circumstances. The
objective of this individualized care strategy is to optimize the advantages of
treatment while limiting any negative consequences.

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Treatment decisions for a person would rely on a comprehensive evaluation

conducted by competent healthcare specialists. Moreover, it is important to note that
not all people diagnosed with schizophrenia have violent tendencies, and treatment
strategies are specifically tailored to target a variety of symptoms and enhance
overall well-being.

2.3.2 Psychotherapy

Psychotherapy, an essential element of mental health treatment, entails examining

ideas, emotions, and actions via dialogue with a skilled mental health practitioner.
Various modalities of psychotherapy can facilitate the cultivation of adaptive coping
strategies, the augmentation of self-consciousness, and the resolution of underlying
factors that lead to propensities for violence.

One notable type of psychotherapy, cognitive-behavioural treatment (CBT), is

particularly helpful in helping patients with mental illness control symptoms and
reduce the likelihood of engaging in violent conduct. Cognitive-behavioural therapy
(CBT) is based on the concept that ideas, emotions, and actions are interrelated,
and by altering negative thinking patterns, one may bring about good changes in
behaviour.

In addition, the scoping study conducted by Aafjes-van Doorn, Kamsteeg, Bate and
Aafjes (2021: 92 - 116) explores the convergence of machine learning and
psychotherapy research. Gaining insight into the changing terrain of technological
integration in psychotherapy improves the accuracy and customization of therapeutic
methods.

Zhou, Hong, Qin and Song (2024: 217-238) study examines the possible additional
treatments for bipolar illness by investigating the combined impact of exercise and
psychotherapy. The combination of physical exercise and psychotherapy treatments
may provide holistic assistance for those diagnosed with bipolar illness.

Lutz, Gómez Penedo, Prinz, Rubel, and Moggia (2024) investigate if certain
individuals exhibit superior responses to various types of psychotherapy when
considering the issue of treatment response variability. This inquiry emphasizes the
significance of customizing psychotherapeutic methodologies to individual attributes
for the most favourable results.

Let's examine Sarah is a 35-year-old lady who has been diagnosed with borderline
personality disorder (BPD). Sarah exhibits severe fluctuations in mood and grapples
with impulsive actions, occasionally leading to episodes of aggression. Sarah
actively participates in Cognitive Behavioural Therapy (CBT) sessions with her
therapist to specifically target and overcome these recurring tendencies.

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Sarah uses Cognitive Behavioural Therapy (CBT) to pinpoint the specific stimuli that
lead to her propensity for violence. By engaging in guided talks, she is able to
identify certain circumstances or ideas that intensify her emotional suffering. Under
the guidance of the therapist, Sarah has the ability to confront and question
pessimistic ideas linked to her triggers. She scrutinizes the legitimacy of these
beliefs and investigates alternate, more beneficial viewpoints. Cognitive-behavioural
therapy (CBT) provides Sarah with effective and tangible techniques for managing
and dealing with challenges. This involves the implementation of relaxation
techniques, mindfulness exercises, and proficient communication skills to effectively
regulate emotional intensity without resorting to acts of violence. The therapy aims to
alter behaviours associated with aggression. Sarah acquires the ability to react to
stimuli in a productive manner, therefore interrupting the pattern of impulsive
responses.

Setkowski, Palantza, van Ballegooijen, Gilissen, Oud, Cristea, Noma, Furukawa,

Arntz, van Balkom and Cuijpers (2023: 1-20) conducted a comprehensive review to
assess the efficacy and acceptability of several psychotherapies for patients
diagnosed with borderline personality disorder (BPD), based on recent research
findings. The findings provide useful information for tailoring psychotherapy therapies
according to the individual's clinical profile.

This debate highlights the changing field of psychotherapy research and its ability to
improve and customize therapies for people with mental illness who are at risk of
violent conduct. It achieves this by using knowledge from many sources.

2.3.3 Anger Management Training

Anger management training is a systematic program created to help individuals

identify triggers, regulate extreme emotions, and cultivate non-violent reactions to
difficult circumstances. This holistic approach encompasses the instruction of several
approaches, such as deep breathing, relaxation exercises, communication skills, and
problem-solving tactics. In order to augment our comprehension of the efficacy of
anger management training, we might glean valuable insights from recent empirical
investigations.

Cochran, Heide, Fox, and Khachatryan (2024: 307-324) employ latent class analysis
to offer insightful statistical profiles of female juvenile homicide offenders. By
comprehending the intricacies of aggressive conduct in young individuals, it is
possible to customize anger management programs for vulnerable groups, even
though the emphasis is on a certain demographic.

Polat and Asi Karakaş's study from 2021 used a randomized controlled experiment
to see how anger management training based on acceptance and commitment
therapy affected forensic psychiatric patients' angry thoughts and impulsive

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behaviour. This study provides valuable insights into the convergence of therapeutic
modalities and anger management, hence creating a comprehensive and integrated
strategy.

Avcioglu and Gokalp (2023: 611-622), conducted an empirical investigation to

evaluate the impact of anger management training on the inclination towards
violence in high school pupils. Investigating the suitability of anger management
techniques in a younger age group provides valuable insights for implementing early
intervention strategies and enhances the overall comprehension of violence
prevention.

Let's examine James is a 28-year-old person who has been diagnosed with
intermittent explosive disorder (IED). This disease is defined by repeated episodes of
angry outbursts that are disproportionate to the context. James enrols in an anger
management program to cultivate effective coping strategies and mitigate the
likelihood of engaging in aggressive conduct.

The application aids James in pinpointing precise stimuli that exacerbate his fury. By
engaging in introspection and receiving direction, he gains insight into the
circumstances or triggers that frequently result in angry reactions.

James acquires the ability to identify bodily manifestations linked to intensifying

anger, such as a heightened heart rate or muscular tightness. This heightened state
of consciousness functions as an early detection system, allowing him to take action
before reaching a state of violence.

Strategies such as numerical counting up to 10 or temporarily removing oneself from

a situation, sometimes referred to as a time-out, are essential elements of James's
anger management repertoire. When faced with a scenario that triggers him, he
utilizes these cognitive tactics to disrupt the automatic intensification of rage.

The program includes relaxation exercises, instructing James on how to practice

deep breathing and gradual muscular relaxation. These strategies assist him in
regulating his physiological arousal and restoring emotional equilibrium.

James engages in role-playing activities to augment his communication proficiency.

Acquiring assertiveness and mastering the skill of expressing emotions effectively
enables him to handle confrontations without resorting to violence.

James is equipped with problem-solving methods through anger management

training. Instead of responding impulsively, he develops the ability to evaluate events
logically and consider productive alternatives, thereby decreasing the probability of
hostile reactions.

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This conversation enhances our understanding of anger management training as a

vital and flexible element in mitigating the risk of violent conduct among those with
mental illness by incorporating information from many sources. The research offers a
detailed comprehension of various demographic groups, therapeutic approaches,
and age ranges, enabling a more customized and efficient use of anger
management techniques. As we investigate these aspects, the complex character of
anger management training becomes apparent, providing a flexible and adaptable
method to reduce the likelihood of violence in different groups of people.

2.3.4 Social Skills Training

Social skills training is a crucial intervention designed to enhance individuals' abilities

in interpersonal communication, empathy, and conflict resolution. The underlying
assumption is that by honing these abilities, individuals are less inclined to rely on
violence as a method of communication or manifestation. An effective social skills
training program may include a range of strategies, such as role-playing exercises,
to promote the practice of proper communication, active listening, and the cultivation
of empathy.

Warner (2020: 432-451) examines the utilization of service-learning as a method for

enhancing interpersonal abilities, with a particular focus on the significance of real-
world applications. Although the primary emphasis is on evaluators, the findings
obtained from this research can provide valuable guidance for developing more
comprehensive approaches to training interpersonal skills, thus aiding in the
prevention of violence.

In his study, Cui (2021) examines the impact of emotional intelligence on promoting
transparency and open communication in the workplace. Gaining an understanding
of the correlation between emotional intelligence and successful communication can
offer significant information for customizing social skills training programs in
professional environments.

Wamsler and Restoy (2020: 1-11) establish a connection between emotional

intelligence and the Sustainable Development Goals, emphasizing its contribution to
the promotion of peaceful, fair, and inclusive communities. This study provides a
more comprehensive outlook on the ways in which improving emotional intelligence
might positively impact social well-being and aid in the avoidance of violence.

Dowd and Green (2022: 197-210) concentrate on instructing adolescents in social

skills, offering a pragmatic manual. This source provides specific techniques and
approaches that may be used in educational environments. It serves as a foundation
for creating effective training programs that focus on improving social skills for
people of different ages.

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Consider Tammy, an adolescent grappling with difficulties managing her anger and
engaging in a program specifically designed to enhance her social skills. By
engaging in role-playing activities, she acquires the ability to identify her triggers,
effectively convey her thoughts and feelings, and demonstrate empathy towards
others. These newly acquired social skills enable her to handle problems without
resorting to violence, leading to a positive transformation in her interactions with both
her family and peers at school.

Based on these study findings and the scenario, we may understand social skills
training as a complex strategy that helps reduce violence. Warner's prioritization of
tangible implementations corresponds with Dowd and Green's dedication to
instructing young individuals in interpersonal abilities. The study by Cui and Wamsler
examines the connection between emotional intelligence and communication,
offering useful insights into the wider societal implications of improved social abilities.

2.3.5 Crisis Intervention and Safety Planning

The execution of a safety plan is a focused tactic designed for those who are in
danger of participating in aggressive conduct. This holistic strategy entails the
methodical identification of possible triggers, the acknowledgment of early warning
indicators, and the development of effective tactics to defuse situations, eventually
requesting aid during a crisis. For example, a meticulously organized crisis
intervention plan may include several components, such as creating a network of
support, gathering emergency contacts, establishing a soothing routine, and outlining
precise steps to be taken when an individual experiences overwhelming emotions or
displays signs of aggression.

Fraser, Saxton, and Jaffe (2023: 1-10) offer views derived from experts in Canadian
Domestic Violence Police Specialists, specifically addressing the difficulties
encountered in ensuring safety planning and risk management for victims and their
children. This study illuminates the pragmatic factors and intricacies associated with
the execution of safety protocols in cases of domestic abuse.

Stanley, Brodsky, and Monahan (2023: 129-136) explore concise and extremely
concise treatments specifically designed for suicide prevention. While not directly
pertaining to violence prevention, these interventions provide valuable insights on
the efficacy of focused and succinct techniques. Gaining a comprehensive
understanding of the subtle distinctions in short interventions might provide valuable
insights for creating effective safety strategies for those who are at risk of engaging
in violent behaviour.

Murphy and Van Brunt (2023: 409-429) examine violence prevention in educational
environments, adding to the ongoing discourse on the topic. Although the primary
concern is classroom disruption, the suggested coordinated actions in this study

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have significant implications for safety preparedness. Gaining insight into the efficacy
of coordinated interventions in mitigating violence inside educational institutions
contributes to the wider conversation surrounding strategies for preventing violence.

Let's examine the situation of Alex, a 28-year-old individual who has been diagnosed
with bipolar illness. Alex has exhibited instances of intensified irritation and hostility,
particularly when confronted with stressful circumstances. In order to tackle this
issue, Alex's mental health practitioner works with them to create a safety plan. The
approach entails the identification of triggers, such as stress connected to the job
and financial burden. Additionally, symptoms such as disturbed sleep patterns and
heightened irritability are often acknowledged as early indicators.

The safety plan includes pragmatic tactics such as contacting a chosen support
network, consisting of trusted friends and family members, in times of stress.
Immediate aid can be obtained by referring to the provided emergency contacts,
which include mental health specialists and a helpline. Alex collaborates with the
mental health expert to design a soothing regimen that incorporates mindfulness
exercises and physical activities.

In addition, the plan delineates precise measures for Alex to take while experiencing
overwhelming emotions or when there is a potential for displaying aggressive
behaviour. These activities may involve a brief cessation from the stressor,
participating in a predetermined soothing activity, and actively seeking expert
assistance.

2.3.6 Community Support and Rehabilitation

Individuals afflicted with mental illness confront the possibility of reintegrating into
society through community-based programs specifically tailored to offer continuous
aid, rehabilitation, and skill enhancement. These programs, which have the goal of
reducing social isolation, boosting self-esteem, and improving general well-being,
are essential for the comprehensive recovery of people. An exemplary instance of
such initiatives is supported employment, which concentrates on assisting persons
with mental illness in both securing and sustaining meaningful employment.
Participating in the labour force has a beneficial impact on individuals' self-esteem,
economic security, and general psychological well-being. These claims are
consistent with other research studies that emphasize the complex nature of
community-based treatments.

Hechanova, Manaois, Co and Escartin (2023: 1-23) examine the biopsychosocial

factors that contribute to drug dependency among Filipino drug users in community-
based drug rehabilitation. This study highlights the significance of comprehending
many aspects that impact drug addiction in community recovery environments.

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Gong, Luo, Liu, Zhang, Chen, Wang, Yang, Yang, Huang and Wang (2023: 420-429)
provide valuable insights on the difficulties experienced by individuals with
schizophrenia who reside in the community. Their narrative research illuminates the
intricate experiences of individuals with schizophrenia, emphasizing the necessity for
customized community-oriented assistance.

Zheng, Zhang, Zhang, Li, Chang and Yang (2023: 1-12) examine the impact of
group-based cognitive-behavioural treatment on the recovery of individuals with
persistent schizophrenia. Focusing on community-based mental health group
rehabilitation, their study gives vital information on the possible advantages of group
therapies.

Shaver, Forsyth and Meritus (2023: 203-217) evaluate the efficacy of a therapeutic
community rehabilitation program for drug misuse in social institutions. This study
enhances our comprehension of how community-based initiatives may efficiently
tackle drug usage problems within social environments.

Let's examine the situation of Alex, a 32-year-old person who has been diagnosed
with bipolar illness. Alex's mental health deteriorated due to his struggles with social
isolation and unemployment. Upon enrolling in a community-based assisted
employment program, he was provided with aid in locating appropriate work
prospects and refining the requisite abilities. Consequently, Alex obtained a part-time
position at a nearby bookshop. The conducive atmosphere, coupled with his
purposeful occupation, not only enhanced his economic security but also elevated
his self-confidence and general psychological welfare. This situation demonstrates
the significant impact that community-based initiatives may have on reintegrating
people with mental illness back into society.

2.3.7 Electroconvulsive therapy (ECT)

Electroconvulsive Therapy (ECT) administers electric currents to the brain with the
goal of provoking a temporary seizure. ECT is commonly used as a last resort for
serious mental diseases after other treatments have failed. Although the exact way it
works is not fully known, ECT is thought to affect brain chemistry and relieve
symptoms of specific mental illnesses. This includes the use of it to treat severe
depression with psychotic symptoms, especially in people who are more likely to
commit suicide or self-harm. Electroconvulsive therapy (ECT) has proven to be
effective in promptly alleviating symptoms and decreasing the probability of
aggressive behaviour linked to severe depression.

The study by Pratt, Parker, Khwaja, and Waite (2023:76) examines the use of
medicine and electroconvulsive therapy in the treatment of aggression. This paper
provides useful insights on the role of ECT in the wider context of preventing and
managing violence in mental healthcare.

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Lupke, Warren, Teodorczuk, Steele, Kolur, Wand, Robinson, and Parker (2023: 403-
419) conducted a comprehensive study to investigate the use of modified
electroconvulsive therapy (ECT) as a possible treatment for delirium. The study
gives a thorough look at how well modified electroconvulsive therapy (ECT) works
for treating delirium. It also shows how it might be used for other conditions besides
psychiatric ones.

The study by Chen, Tan, and Tor (2023: 330) looks at how the quantity of prior
sickness episodes affects the initial response to electroconvulsive treatment (ECT) in
various mental disorders. This study, which examines the relationship between a
patient's mental history and their reaction to ECT, provides valuable insights into the
variability of ECT outcomes.

Tartt, Mariani, Hen, Mann, and Boldrini (2023: 1-3) investigate the correlation
between electroconvulsive treatment and neuroplasticity. This study explores the
capacity of ECT to influence neuroplastic processes, providing insight into its wider
impact on brain function.

These several studies jointly enhance our comprehension of electroconvulsive

treatment, its uses, and its influence on aggressive behaviour in patients with
profound mental illness.

Let's look at a person named Alex who has been experiencing persistent bouts of
severe depression along with psychotic symptoms while undergoing various therapy
techniques. Conventional therapy methods, such as different medicines, have had
restricted efficacy. Given the increased susceptibility to self-harm and suicide, Alex's
mental health team is contemplating ECT as a possible option.

Following a comprehensive assessment of Alex's situation, which took into account

the frequency and intensity of past episodes of sickness, the mental health experts
have determined that it is appropriate to pursue a course of ECT. Following the
administration of the medication, future sessions will reveal notable improvements in
depressive symptoms and a decrease in psychotic aspects. Alex's propensity for
self-harm decreases, and the medication not only provides quick relief from
symptoms but also reduces the probability of engaging in aggressive conduct linked
to severe depression.

This scenario exemplifies a circumstance in which ECT emerges as a vital and

efficient technique for handling severe mental illness and reducing the likelihood of
violent conduct in an individual with intricate psychiatric difficulties.

2.3.8 Transcranial magnetic stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) uses magnetic fields to stimulate targeted
areas of the brain without the need for intrusive procedures. This technique has

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shown promising outcomes in reducing depressive symptoms and enhancing

general mood, especially in the treatment of depression. For example, those
suffering from depression who have not shown improvement with conventional
treatments such as medicine or psychotherapy or who cannot tolerate the adverse
effects of antidepressants may consider TMS as a feasible option.

Weise, Numssen, Kalloch, Zier, Thielscher, Haueisen, Hartwigsen, and Knösche

(2023: 293-318) have conducted research on the accurate mapping of motor
functions using transcranial magnetic stimulation. Their work provides detailed
information on the technical elements of this therapeutic method.

Researchers Perera, Alekseichuk, Shirinpour, Wischnewski, Linn, Masiello, Butler,

Russ, Schroeder, Falchier, and Opitz (2023: 8649-8662) looked into how the effects
of centrally and peripherally induced transcranial magnetic stimulation differed in
nonhuman primates. Their findings shed light on the complex effects of TMS.

The use of multimodal acquisitions in the study by Sack, Schuhmann, and de Graaf
(2023: 349-373) has improved our understanding of non-invasive brain stimulation.
This research has offered a more comprehensive outlook on the many applications
and methodologies related to transcranial magnetic stimulation (TMS).

Imagine a situation in which Alex, a 32-year-old person diagnosed with treatment-

resistant depression, has not found substantial relief from conventional treatments
such as antidepressant drugs and psychotherapy. Alex is looking for an alternate
method to handle symptoms of depression and reduce the chance of their conduct
becoming aggressive since they find the negative effects of pharmaceuticals
unbearable.

Given the research findings of Weise et al. (2023: 293-318), Alex's mental health
expert suggests utilizing TMS as a suitable course of action. TMS offers precise
motor mapping that is tailored to Alex's specific requirements, providing a focused
therapeutic intervention. By incorporating the findings of Perera et al. (2023: 8649-
8662), this individualized strategy recognizes the intricate impacts of TMS and offers
a customized remedy for Alex's intricate situation.

During Alex's TMS sessions, the therapy demonstrates efficacy in alleviating

symptoms of despair, impatience, and restlessness. TMS, by targeting depressive
symptoms, significantly reduces the likelihood of aggressive conduct linked to severe
depression in this situation. This example demonstrates the potential of TMS, which
is informed by research and tailored to individual circumstances, to provide optimism
and therapeutic alleviation for patients grappling with complex mental health
disorders.

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Notably, although ECT and TMS can be effective treatments for specific mental
health disorders, they are typically reserved for specific cases and administered
under the supervision of trained healthcare professionals. These treatments are not
first-line options and are typically contemplated only after other options have been
investigated. The choice between electroconvulsive therapy (ECT) and transcranial
magnetic stimulation (TMS) should be made on an individual basis, taking into
account the patient's specific diagnosis, treatment history, and potential risks and
benefits. In addition to traditional treatments, alternative treatments, such as
acupuncture, yoga, and meditation, are used to manage the symptoms of mental
illness.

2.4 Different impact among individuals with mental illness

2.4.1 Medication

In the labyrinth of mental health, the relationship between medication and the
propensity for violent behaviour in individuals with mental illness is a convoluted
narrative. It isn't a linear equation; it's a symphony of variables orchestrated by the
nature and severity of the illness, the specific prescription nuances, and the
idiosyncratic responses to therapeutic interventions. Respected academics from
various fields related to mental health have dissected this story, each adding a
crucial note to the symphony.

Consider the symphony of recovery that Mathew, Nirmala, and Kommu (2023: 78-
85) explored in the context of schizophrenia. This isn't merely a subjective
exploration; it's a profound revelation of the subjective importance of recovery. It lays
bare the intricate dance between recovery paths and the medication landscape.
Understanding the nuances of individual experiences becomes not just a scholarly
pursuit but a necessity to tailor treatment strategies, ensuring a harmonious
reduction in the likelihood of venturing into violent conduct.

In the digital age, Camacho and Torous (2023: 534-538) navigate the uncharted
waters where mental health meets technology. This isn't just about digital literacy; it's
a futuristic exploration of the effects of technology on medication outcomes. In a
world where interventions blend with the digitized pulse of society, the efficacy of
medicine in curbing aggressive conduct takes centre stage. It's not just about
medicine; it's about medicine in a technologically entwined world.

The exploration deepens with Søgaard Juul, Jensen, and Fink-Jensen (2023),
delving into the realm of traditional psychedelics. This isn't a casual exploration; it's a
profound insight into the intricate dance between psychedelics and mental health
settings and their potential consequences for aggressive conduct. It's a call to
comprehend the uncharted territories of drug use within mental health, highlighting
the multifaceted influences on violent propensities.

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Now, consider Tonna, Lucarini, Lucchese, Presta, Paraboschi, Marsella, Daniel,

Vitale, Marchesi and Gobbi (2023: 447-461) and their exploration of posture, gait,
and self-disorders in schizophrenia. This isn't merely a biomechanical investigation;
it's an integral part of the multidimensional approach to mental health therapy.
Understanding these intricacies becomes pivotal for physicians, not just in
prescribing medicine but in making nuanced judgments about its potential influence
on the complex tapestry of violent propensities.

Kelly, Koay, Mineva, Volz, McCool, McLoughlin, Conluain, Sharma, Kerr, Franklin
and Grimes (2023: 50-60) enter the scene, examining non-professional medication
practices during public health emergencies. This isn't just a study; it's a
comprehensive examination, emphasizing the significance of accounting for external
variables and unforeseen circumstances. Medicine isn't just a passive actor; it's an
active participant in the unpredictable landscape of emergencies and their impact on
mental well-being and aggressive conduct.

In a final crescendo, Chan and Tsui (2023: 322) cast a spotlight on the enduring
impact of discrimination on mental well-being. This isn't just about prejudice; it's a
meticulous analysis of its long-term effects. Discrimination becomes a formidable
force, casting a shadow on the effectiveness of medicine and its potential to prevent
aggressive behaviour.

Let's look at a case study on Alex, a 32-year-old individual diagnosed with

schizophrenia, navigating the intricate landscape of mental health. Alex's journey is
not just a personal one; it's a microcosm reflecting the intricate dance between
medication and the propensity for violent behaviour.

In Mathew et al. (2023) exploration, Alex's subjective experience of recovery takes

centre stage. It's not just about medication; it's about the significance of recovery
paths tailored to Alex's unique journey. Understanding the profound importance of
this subjective dance becomes pivotal in curating a treatment strategy that doesn't
merely address symptoms but orchestrates a harmonious reduction in the likelihood
of venturing into violent conduct.

As Camacho and Torous (2023: 534-538) introduce the digital symphony into Alex's
narrative, it's not just about digital literacy; it's about the fusion of mental health with
technology. In a world where interventions are digitally entwined, the efficacy of
Alex's medication becomes a futuristic exploration. It's not just about medicine; it's
about medicine in a technologically driven society, impacting its role in mitigating
aggressive conduct.

The journey continues with Søgaard Juul, Jensen, and Fink-Jensen's (2023: 367-
378) psychedelic insights. Alex isn't merely a patient; he's an explorer in the realms
of traditional psychedelics. The study unfolds as a guide to comprehending the

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uncharted territories of drug use within mental health settings, shedding light on the
potential consequences of aggressive conduct in individuals like Alex.

In the exploration of posture, gait, and self-disorders by Tonna et al. (2023: 447-
461), Alex's journey takes a multidimensional turn. It's not merely a biomechanical
investigation; it's an integral part of Alex's mental health therapy. Understanding
these intricacies becomes pivotal for Alex's physician, making nuanced judgments
about the potential influence of medication on the complex tapestry of violent
propensities.

As Kelly et al. (2023: 50-60) delve into non-professional medication practices during
public health emergencies, Alex becomes a protagonist in an unpredictable
landscape. It's not just a study; it's a comprehensive examination, emphasizing the
significance of accounting for external variables and unforeseen circumstances.
Medicine isn't just a passive actor; it's an active participant in Alex's journey through
emergencies and their impact on mental well-being and aggressive conduct.

The analysis by Chan and Tsui (2023) of the long-term effects of prejudice on people
like Alex comes last. Discrimination becomes a formidable force, casting a shadow
on the effectiveness of medication and its potential to prevent aggressive behaviour
in the ongoing narrative of Alex's life.

Alex's story is not just the sum of medication and its potential impact on violent
behaviour; it's a symphony of personalized recovery, technological integration,
psychedelic exploration, multidimensional therapy, emergency resilience, and the
enduring shadows of prejudice. These diverse melodies in Alex's journey underscore
the imperativeness of tailored and comprehensive approaches, orchestrating a
nuanced harmony that resonates beyond the realms of violent behaviour in
individuals with mental illness.

To synthesize these diverse melodies into a concluding note, the relationship

between medicine and aggressive conduct in people with mental illness is a
complex, multifaceted symphony. These studies aren't isolated notes; they are
integral movements in understanding this correlation. They underscore the
imperativeness of tailored and comprehensive approaches, not merely in addressing
mental health but in orchestrating a nuanced harmony that resonates beyond the
realms of violent behaviour.

2.4.2 Therapy

Therapy, a powerful tool to combat the threat of violent conduct in those with mental
illness, is not just an option but an essential foundation. The debate progresses
through several therapeutic environments, each with its own unique expertise.

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Cognitive-Behavioural Therapy (CBT) is a steadfast champion in the ongoing fight

against violent inclinations. Lewis, Roberts, Andrew, Starling, and Bisson (2020)
conducted a meta-analysis that strongly asserts that CBT is not only a therapeutic
method but also a strategic assault against the negative thinking patterns that
contribute to violent tendencies. This is not simply psychotherapy; it is a deliberate
dismantling of the cognitive framework that supports hostility.

Introducing Dialectical Behaviour Therapy (DBT), a powerful and influential approach

to managing and controlling emotions. The study by Mavranezouli, Megnin-Viggars,
Daly, Dias, Welton, Stockton, Bhutani, Grey, Leach, Greenberg, and Katona (2020:
542-555) emphasizes that DBT is not just a form of therapy but also a potent
defence against the storm of violence. This is not only therapy; it is the process of
developing emotional strength and adaptability through the intense experience of
mental well-being.

The discussion encompasses the realm of family, acknowledging that violence

fundamentally intertwines with issues inside the family unit. The statement aligns
with the comprehensive storyline of family therapy, recognizing that the complex web
of familial connections may either give rise to violence or act as a catalyst for its
change. Therapy is not simply a conversation confined to a room; it is a complex
interaction with the forces that influence behaviour outside of the person.

However, an individual therapeutic attempt may occasionally struggle when

confronted with extreme indications. Here, the debate shifts towards an integrated
strategy—a strategic alliance of therapy, medicine, hospitalization, or intense
outpatient care. The study by Lewis et al. (2020) not only emphasizes the
effectiveness of therapy but also stresses the critical need for a coordinated strategy
to address serious mental health issues.

The argument is not isolated but rather resonates within a harmonious convergence
of evidence. The meta-analysis conducted by Bighelli, Wallis, Reitmeir,
Schwermann, Salahuddin, and Leucht (2023: 779-810), sheds light on the influence
of psychological therapies on the functioning of individuals with schizophrenia. It
supports the notion that therapy is a complex tool that has various impacts on
functional outcomes.

Imagine a scenario in which an individual, who frequently has episodes of

aggressive behaviour, undertakes an extensive therapeutic treatment plan. By
implementing a comprehensive approach that includes CBT, DBT, and family
therapy, based on the concepts derived from extensive and reliable meta-analyses,
the person not only witnesses a decrease in violent inclinations but also sees a
significant change in managing emotions and improving relationships with others.
The incorporation of many therapeutic approaches becomes not only a choice but a
customized array of strategies for a sophisticated fight against aggressive conduct.

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Therapy beyond the traditional limits of intervention. It is not a quiet conversation; it

is an aggressive barrage of transformation. Therapy, in its various forms, is a
powerful tool that may help break bad patterns, build emotional strength, and
address complex family dynamics. It serves as an effective countermeasure against
aggressive conduct. The argument unequivocally asserts that therapy is not only a
suggestion but rather a powerful tool that may decisively influence the outcome of
the struggle for mental well-being.

2.5 The severity of the mental illness affect the risk of violent behaviour

The prevalent notion that associates mental illness with violence oversimplifies a
complex reality. It is essential to recognize that the vast majority of people dealing
with mental health issues are, indeed, peaceful. Nevertheless, extensive research
reveals that some mental disorders, when not properly addressed or controlled,
might heighten the likelihood of engaging in violent actions.

Consider the case of undiagnosed schizophrenia, a severe and persistent mental

illness characterized by hallucinations, illusions, and altered cognition. Studies,
including the works of Masserano, Hall, Wolf, Diedrich, Gupta, Yu, Johnson, and
Mittal (2024) and Lawrence, Becker, and McGorry (2023: 1-59), suggest that if
symptoms of schizophrenia are not treated, they have the potential to progress into
violent behaviours. If not handled appropriately, the individual's skewed perception of
reality and impaired cognitive functions may lead to violent conduct. However, by
implementing a comprehensive treatment approach that includes medication
management, therapy, and strong social support, the symptoms of schizophrenia
can be successfully controlled. This not only reduces the likelihood of aggressive
conduct but also promotes general psychological well-being.

Furthermore, the severity of the mental disease itself plays a crucial role in
determining the likelihood of engaging in violent behaviour. People suffering from
untreated severe conditions such as schizophrenia or bipolar disorder may
experience psychosis, delusions, and hallucinations. These factors are linked to a
higher probability of engaging in violent behaviour, as discussed in the works of Wolf
and Winston (2023: 166) and Burns and Marder (2023: 469-492). Likewise,
individuals grappling with profound personality problems or drug use disorders may
demonstrate an increased likelihood of participating in violent conduct.

Nevertheless, it is crucial to emphasize the complex and varied factors that

contribute to aggressive conduct within the framework of mental illness. Elements
such as a prior record of violence, substance abuse, or a lack of adequate support
can together add to the intricate nature of aggressiveness. The writings of Burke,
Ellis, Peltier, Roberts, Verplaetse, Phillips, Moore, Marotta, and McKee (2023: 4034-
4060), Saleh, Jackson, Burton, and Ahmed (2023: 1-30), and Nadeem, Riaz,
Hosawi, Altayb, Ud-din, and Fazal (2023: 215-253) support this point of view by

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showing how bad experiences in childhood, evaluation and treatment methods, and
the way antipsychotic drugs work to understand and deal with aggressive behaviour
are all complicated and affect each other.

Let us examine the situation of Jordan, who is grappling with undiagnosed

schizophrenia. Jordan has intense hallucinations and altered cognition, which pose a
multifaceted difficulty. Without accurate diagnosis and attention, these symptoms
may worsen, potentially causing Jordan to see ordinary circumstances as dangers,
with the possibility of escalation to aggressive conduct.

Nevertheless, by providing appropriate attention, the storyline undergoes a

favourable transformation. By utilizing the findings of Masserano et al. (2024), and
Lawrence et al. (2023), a mental health practitioner develops a thorough treatment
plan. This includes the use of specific medications to target the molecular
imbalances linked to schizophrenia, counselling sessions to assist Jordan in
navigating the intricacies of their altered perception of reality, and a strong social
support network encompassing their family and friends.

As Jordan conscientiously adheres to this individualized treatment regimen, the

hallucinations progressively diminish, and the disordered cognition starts to improve.
The likelihood of engaging in violent action decreases dramatically. This case
highlights the complex relationship between the seriousness of mental illness and
the likelihood of violence, underscoring the significant effect of individualized
treatments in guiding an individual away from a course of action that may have
resulted in destructive behaviour.

To summarize, the connection between the seriousness of mental illness and the
likelihood of engaging in violent action is not a single, uniform story. The relationship
between mental health and aggressiveness is a complicated and interrelated
network of elements. In order to effectively address this issue, it is crucial to
implement customized treatments that incorporate different therapy approaches and
support systems.

2.6 The role of family and community support

The intricate interconnection of mental health incorporates familial and community

support as crucial factors in preventing violent conduct among people struggling with
mental illness. Townsend, Dillard-Wright, Prestwich, Alapatt, Kouame, Kubicki,
Johnson, and Williams (2023: 227) provide persuasive research that highlights the
significant impact of social support on improving mental health outcomes and
reducing the propensity for violence. They emphasize that social support is not just
an additional factor but rather a powerful and active force.

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Within the context of family, the influence of support is easily noticeable. In addition
to providing support, family and friends actively participate in the process of
managing mental health. Emotional support, a powerful instrument, encourages
individuals to comply with treatment. Support networks are crucial for navigating the
complex healthcare system, serving as intermediaries between mental health
difficulties and larger support structures.

Importantly, familial and communal relationships go beyond providing emotional

support. According to Kallivayalil, Kastrup, Gogineni, Di Nicola, and Sharma (2023:
9), vigilance is a sign of community support. Friends and family frequently serve as
the initial barrier, identifying indicators of imminent violent conduct. Equipped with
information, they may promptly deploy crucial mental health resources, establishing
a proactive safeguard against escalation.

The importance of community support in reducing the danger of violence cannot be

emphasized enough. It is crucial to have access to mental health care, secure
housing, and a meaningful job. Community-led initiatives, such as peer support
groups and local mental health clinics, are effective treatments that directly address
urgent mental health issues and simultaneously decrease the likelihood of violence.

Education plays a powerful role in this collaborative endeavour. According to

research by Townsend et al. (2023: 227), spreading information through awareness
campaigns aids in eradicating the stigma associated with mental illness. These
programs promote the development of a knowledgeable and empathetic community,
which leads to a shared comprehension of the variables that influence violent
conduct.

Consider a situation in which Taylor, an individual grappling with profound anxiety

and depressive symptoms, is navigating their path towards mental well-being. Within
this particular framework, Taylor's family assumes a pivotal role as a fundamental
pillar in their network of assistance. Taylor's cousin, who possesses a sharp ability to
detect little changes in behaviour, carefully watches for indications of increased
anxiety. Equipped with knowledge acquired from community awareness programs,
the cousin engages in open dialogue with Taylor around mental health.

Concurrently, the community serves as an essential support system for Taylor's

recuperation. Taylor finds peace and develops helpful coping techniques through
participation in support groups offered by local mental health clinics. Taylor is able to
get professional care for mental health issues without feeling judged, thanks to
mental health services that are easily available and based on community-driven
knowledge of mental health dynamics.

The family, equipped with information from public awareness campaigns, ensures
that Taylor strictly follows therapy and medication regimens. By actively participating,

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they become champions, not just for Taylor but also for promoting inclusion of
mental health across the community. This collective endeavour fosters a community
that not only embraces but actively advocates for those with mental illness, therefore
mitigating the likelihood of violent conduct through well-informed and empathetic
intervention.

To summarize, Townsend et al. (2023: 227) highlight that family and community
support play an active role, rather than a passive one, in the context of mental health
and violence prevention. These individuals have the ability to significantly alter
results, ranging from providing emotional support and ensuring compliance with
therapy to promoting widespread comprehension and acceptance among the
community.

2.7 Access to mental health care affect the risk of violent behaviour among
individuals with mental illness

The accessibility of mental health care emerges as a critical determinant in shaping

the trajectory of violent behaviour among individuals with mental illness. According to
strong empirical evidence, those who receive comprehensive mental health
treatment are significantly less likely to engage in violent behaviour than those who
do not. Swanson, Borum, Swartz, and Hiday (1999: 185-204) highlight this point.

Effective mental health treatment becomes a linchpin in steering individuals away

from violent behaviour. Elbogen, Mustillo, Van Dorn, Swanson, and Swartz (2007)
highlight the pivotal role of treatment in symptom management, emphasizing how
medications and psychotherapy act as potent tools in mitigating anger, aggression,
and impulsivity—key contributors to violent behaviour. Additionally, a nuanced
understanding, as put forth by Roché, Boyle, Cheng, Del Pozzo, Cherneski,
Pascarella, Lukachko, and Silverstein (2021: 2732-2752), reveals the prevalence
and risks connected with violent ideation, further emphasizing the protective role of
adequate mental health care.

However, as Langan (2010: 85-100) makes clear, a stark reality still exists for those
who are dealing with mental illness, particularly those who are uninsured or
underinsured. The hurdles in accessing mental health care intensify the risk of
untreated or inadequately treated mental illness, subsequently elevating the
propensity for violent behaviour.

Strategic interventions to bolster mental health care access become imperative.

Elbogen, Dennis, and Johnson (2016) advocate for comprehensive approaches
transcending the narrow lens of mental illness, emphasizing the need for targeted
pathways to address the complex interplay between mental health and violence.
According to Silver (2006: 685-706), initiatives like increased funding, expanded
insurance coverage, and improved service accessibility in underserved areas

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emerge as crucial steps toward reducing the risk of violent behaviour among people
with mental illness.

Consider the case of Alex, a 30-year-old individual grappling with untreated

schizophrenia. In the absence of mental health care access, Alex experiences
persistent hallucinations and delusions, contributing to heightened irritability and
aggression. According to Swanson et al. (1999: 185-204), the lack of comprehensive
treatment exacerbates these symptoms, increasing the likelihood that Alex will act
violently.

Contrastingly, envision a scenario where Rachel, also 30, has seamless access to
mental health care. Under the care of a comprehensive mental health treatment
plan, including psychotherapy and medication, Rachel learns effective coping
strategies to manage her bipolar disorder. This aligns with the insights provided by
Roché et al. (2021: 2732-2752), emphasizing the pivotal role of treatment in curbing
violent ideation.

However, the contrast doesn't end with individual cases. Take the broader context
where community-based mental health services are readily accessible, reflecting the
advocacy of Silver (2006: 685-706). In such a community, individuals like Alex and
Rachel find support not just in treatment but also in social structures, reducing the
overall likelihood of violent behaviour.

This scenario underscores the critical nature of mental health care accessibility. By
addressing the unique needs of individuals and fostering supportive environments, it
becomes possible to navigate away from the potential risks of untreated mental
illness and subsequent violent behaviour.

The argument converges on the pivotal role of mental health care accessibility in
shaping the likelihood of violent behaviour among individuals with mental illness.
Through targeted interventions, inclusive of funding, coverage expansion, and
heightened awareness, it becomes possible to harness the potential of effective
treatment and support in curtailing violent tendencies in this population.

3. Section 3: Conclusion and recommendation

3.1 Findings

- Psychosis and personality disorders have been regularly identified as

significant factors that increase the likelihood of people with mental illness
engaging in violent conduct. This underscores the crucial connection between
certain mental health disorders and the likelihood of exhibiting aggressive
inclinations.
- Pivotal risk factors for violent conduct in the setting of mental illness include
an individual's history of violence, substance addiction, and poor social

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support. This discovery emphasizes the complex nature of the several

elements that influence the probability of violence in people with mental
illness.
- Treatment with medication and therapy has shown promising effectiveness in
reducing the likelihood of aggressive conduct linked to mental illness.
Nevertheless, the effects of these therapies varied depending on the
particular characteristics and seriousness of the individual's mental health
condition. This emphasizes the significance of customizing therapy methods
to suit the distinct attributes of the specific mental disorder at hand.
- The study found that both family and community support played a crucial role
in dramatically reducing the likelihood of aggressive conduct in those dealing
with mental illness. The provision of this support framework, which includes
ensuring emotional stability and recognizing possible stimuli, is essential for
cultivating a stable setting.
- Comprehensive access to mental health treatment, including both medication
and therapy, was crucial in lowering the likelihood of aggressive conduct in
adults with mental illness. There has been evidence that the accessibility and
personalization of these treatments have a significant impact on their efficacy.

The results highlight the complex relationship between particular mental health
disorders, personal variables that increase the likelihood of harm, treatments, and
support networks in impacting the probability of aggressive conduct in persons with
mental illness. This sophisticated comprehension enhances the implementation of a
more all-encompassing strategy for mental health treatment and violence prevention.

The findings of this study support previous research that identified certain mental
diseases and individual circumstances as contributing to violent conduct. However,
what sets these findings apart is the detailed examination of how therapy and
medication affect the unique characteristics of different mental illnesses. This
underscores the necessity for tailored treatments in the realm of mental health care.

The findings corroborate prior studies by strengthening the link between certain
psychiatric conditions, individual predisposing variables, and the probability of
engaging in aggressive conduct. Nevertheless, the focus on the subtle effects of
therapeutic treatments enhances comprehension, highlighting the necessity for
customized strategies.

The findings effectively integrate the components of mental health disorders,

personal variables, therapeutic methods, and support networks. The significance of
each element is emphasized in the context of reducing the likelihood of aggressive
conduct among those with mental illness.

The findings constitute a comprehensive amalgamation of current literature and

research, integrating ideas from studies on mental illnesses, risk factors for violence,

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therapeutic methods, and support systems. This all-encompassing approach offers a

thorough knowledge of the intricate processes at play.

The organized presentation follows the prescribed technique, in accordance with the
list of questions gathered throughout the study. Every discovery aligns with the
particular facets examined, guaranteeing lucidity and consistency.

The findings simultaneously corroborate and question established beliefs. While

acknowledging the established correlations between mental problems and
aggression, the intricate effects of therapy and medicines question oversimplified
methodologies. The practical ramifications of these findings emphasize the necessity
for individualized and readily available mental health services.

Table 1: Psychiatric Diagnostic and Patterns of Aggression and/or Violence

The practical ramifications of these discoveries are significant. The significance of

customized mental health interventions, easily available care, and strong support
networks in mitigating the likelihood of aggressive conduct among those with mental
illness is underscored. These findings have immediate consequences for mental
health legislation, clinical procedures, and community support programs.

The table provides a concise overview of the patterns of aggressiveness and

violence linked to different mental illnesses across various age groups. Impulsive
conduct and verbal aggressiveness are associated with illnesses such as ADHD and
Oppositional Defiant Disorder in children and teenagers. Personality disorders,

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including Antisocial Personality Disorder, display conduct characterized by scorn and

exploitation. Psychiatric diseases such as Post-Traumatic Stress Disorder (PTSD)
and Bipolar Disorder are distinguished by heightened anger and violence, which are
frequently intensified by substance abuse. Paranoid delusions can trigger aggressive
behaviour in individuals with schizophrenia. Dementia in the older population is
linked to widespread irritation and self-protective behaviours that are harmful in
nature. This thorough review highlights the various ways in which mental health
issues and violent behaviours are connected at different stages of life..

To summarize, this study has explored successful tactics for reducing aggressive
conduct in adults with mental illness, specifically inside a designated station or
corporate setting. The research highlights the significance of customized therapies,
encompassing medicine, psychotherapy, and strong family and community support.
Although the ideas offered show potential, they are not without constraints. The
study addresses difficulties such as small sample sizes, limited applicability to a
broader population, and a concentration on observational studies, which reflect the
intricate nature of the relationship between mental health and violence.
Nevertheless, the importance of these discoveries goes beyond the current situation,
suggesting suggestions that are applicable to other stations and enterprises. The
universal principles of mental health care include customizing treatment, including
support systems, and prioritizing ease of access, which may be widely implemented.
However, there is also a significant amount of information that is not yet understood,
particularly on the lasting impacts of treatments and the complex relationship
between many variables that contribute to violence. The lack of understanding in this
area highlights the necessity for doing more extensive research that includes a wider
range of participants and longer follow-up periods. This will help to strengthen the
existing evidence and provide thorough guidance for beneficial methods.

3.2 Recommendations

- Create targeted screening and intervention programs that prioritize the

training of mental health professionals to identify and address the distinct
problems presented by various mental illnesses linked to a heightened
likelihood of engaging in violent conduct.
- Use all-around treatments that focus on mental health issues and other risk
factors, like drug abuse and a history of aggression, to provide complete help
and lower the likelihood of aggressive behaviour in people who are at high
risk.
- Promote a personalized approach to mental health treatment, prioritizing
continuous evaluation and modification of medication and therapy techniques
according to the unique attributes of each individual's mental disorder.
- Enhance knowledge and comprehension of mental health concerns among
families and communities, establishing support systems that foster emotional
stability and mitigate possible catalysts for aggressive conduct.

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- Pay attention to efforts that aim to improve the accessibility and customization
of mental health services. For example, increasing financial resources,
making insurance more open to more people, and changing therapies to meet
the specific needs of each person, while taking into account the severity of
mental disorders and other problems that are happening at the same time.

3.3 Limitations

- Sample Characteristics: Numerous studies have limited sample sizes, hence

restricting the applicability of findings and frequently concentrating on certain
mental health disorders.
- Study Design Challenges: Difficulties in carrying out extensive randomized
controlled trials (RCTs) in the field of mental health necessitate reliance on
observational studies that may include inherent defects and limits.
- The heterogeneity of mental disease poses a challenge in generalizing the
effectiveness of treatments across various disorders.
- Numerous factors, including personality traits, environmental factors, health
factors, and social contexts, have an impact on the multifaceted nature of
violence. Consequently, comprehending how therapeutic approaches might
uniformly mitigate violent behaviour is a significant challenge.
- Long-term Effects: Insufficient follow-up periods in several studies impede
comprehension of the enduring consequences of treatment, thereby
demanding further investigation into the durability of treatment benefits.
- Publication bias refers to the potential bias in favour of publishing studies that
have favourable or statistically significant outcomes, which can have an
impact on the total body of evidence.
- Although the current study provides a basis, more research is crucial to
thoroughly tackle these limitations and enhance our comprehension of how to
efficiently diminish the risk of violent conduct among people with mental
illness.

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5. Declaration

I, Sherise Nundhkumar declares that this portfolio of evidence/assignment is my own

original work and I did not copy any person’s work. I also understand Unisa
Plagiarism policy, which prohibit the submission of plagiarized work as one’ own
work. Where I have used information from other sources, a list of reference and in-
text reference was provided in order to acknowledge the original authors of the
information.

Signature:

Date: 16 January 2024

Place: Residence

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