MUSINGS on MURDER, PSYCHOSIS and STIGMA

Powerful statements today, from wise and wonderful women in our society, advocate for better services for women to deal with violence and sexual assault against women.

But prevention of violent and sexual assault against women also requires more attention to the violent men who are usually the perpetrators.

Much of the current approach to violence and sexual assault of women naturally focuses on assisting victims and their families with their trauma, ensuring their safety and educating them on how to remove themselves from dangerous situations. That is all necessary and appropriate. However, it is partly a matter of closing the stable door after the horse has bolted.

Having psychiatrically assessed many violent offenders and sexual offenders, I believe extra resources would be usefully applied to the assessment of violent and sexual offenders, or potential offenders, to provide a degree of prevention before severe offences occur. That means men should be part of the overall strategy to reduce violence against women.

The more men that are assessed, the better would we understand the motivations and causes of violence. Early interventions would potentially prevent more serious offending. Better risk assessment strategies could be developed. Legal or Mental Health interventions could be better tailored and delivered.

It is not sufficient to label offenders as simply evil and to lock them up. Incarceration may well be the appropriate punishment but if we properly examine the offenders, their behaviour and the causal factors behind their offences, we will be better able to prevent repeat offences and reduce future cases of similar trauma and tragedy.

The machismo persona of a violent offender will often hide a background of deprivation and abuse. Their angry, paranoid, controlling behaviour is perhaps a reflection of great inner fear and insecurity. Drug and alcohol abuse will be both a symptom of underlying problems and a potent cause of releasing dangerous aggression and paranoia. Quite a few of such men may have such psychopathic personality traits as to be irretrievably dangerous men. But others are potentially salvageable with appropriate assistance; such that they can go on to useful and productive lives.

Being able to sort out the wheat from the chaff, the salvageable from the hopeless cases, would be the aim of comprehensive assessment processes.

Women need education about how to manage potential domestic violence and ensure their safety. Many men also need such education, increased self-awareness and assistance in managing risk factors, such as drug and alcohol abuse and anger issues.

Practical strategies will be needed, not just good intentions. For example, there could be legislation to ensure that when Domestic Violence Orders are made in Court, both parties would be required to undergo an assessment process by relevant professionals. Offenders sent to prison could be required to have a similar assessment. Treatment programs could be prescribed and enforced.

Setting up a suitable group of professionals (to include psychiatrists, psychologists, and drug abuse experts) to do this work would be expensive and demanding, but would potentially repay the effort with reduced offending and trauma in the community. Such an expert group would give the opportunity to develop much improved risk assessment measures and strategies, targeted treatment programs and violence prevention strategies.

Prevention is better than cure. When it comes to violence and sexual assault, a realistic, sophisticated and nuanced approach is needed. Both victims and offenders must be a part of the investigation, to inform our understanding and design the treatment approaches necessary to have better outcomes.

Our sympathies are with the victims, but a hard-nosed approach to prevention will require us to confront the offenders as part of the solution.

Dr Donald Grant is a forensic psychiatrist with wide experience in the assessment of violent offenders, sexual offenders and victims of these offenders.