Sertraline hydrochloride for reducing impulsive behaviour in male, repeat-violent offenders (ReINVEST): protocol for a phase IV, double-blind, placebo-controlled, randomised clinical trial.

INTRODUCTION: Considerable evidence supports an association between poor impulse control (impulsivity) and violent crime. Furthermore, impulsivity and aggression has been associated with reduced levels of serotonergic activity in the brain. Selective serotonin reuptake inhibitors (SSRIs) are a class of anti-depressants that aim to regulate brain serotonin concentrations. Several small studies in psychiatric populations have administered SSRIs to impulsive--aggressive individuals, resulting in reduced impulsivity, anger, aggression and depression. However, no clinical trial has been undertaken in a criminal justice population. This protocol describes the design and implementation of the first systematic study of the potential benefits of SSRIs in impulsive---violent offenders who are at high risk of reoffending. METHODS AND ANALYSIS: A randomised, double-blinded, multicentre trial to test the clinical efficacy of an SSRI, sertraline hydrochloride, compared with placebo on recidivism and behavioural measures (including impulsivity, anger, aggression, depression and self-reported offending) over 12 months. 460 participants with histories of violence and screening positive for impulsivity are recruited at several local courts and correctional service offices in New South Wales, Australia. ETHICS AND DISSEMINATION: Results will be submitted for publication in a peer-reviewed journal. Possible implications of the effectiveness of this pharmacological intervention include economic benefits of reducing prison costs and societal benefits of improving safety. This study has received ethical approval from the University of New South Wales, Aboriginal Health & Medical Research Council, Corrective Services NSW and the NSW Justice Health and Forensic Mental Health Network. TRIAL REGISTRATION NUMBER: ACTRN12613000442707.

Firearms regulation, violence and the mentally ill: a contemporary Antipodean appraisal.

As recent cases of mass murder at Utoya Island in Norway, and in the United States (US) at Virginia Tech, Virginia; Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut all illustrate, acts of extreme violence involving high powered weapons and committed by persons with a presumed or confirmed mental illness tend to arouse intense public and political debates about the efficacy of firearm regulation and control. Following these tragedies, in the US at least, various law reform measures have been proposed and in some cases implemented designed principally to make it more difficult for mentally ill persons to gain access to firearms. In this article it is contended that measures like these are at best tinkering with the margins of gun control and also have the tendency to reinforce the stigma and discrimination experienced by persons with a mental illness, while perpetuating stereotypes of them as dangerous to themselves and others. Despite these limitations, and while firearm regulation policies and practices vary widely across the globe, most nations still seek in some way to limit access to guns by persons with a mental illness. This article explores in more detail how such policies and practices have been applied in the Australian State of New South Wales and the lessons to be learned elsewhere from this experience.

Workplace violence in Hong Kong, China: nature, impact, and preparedness.

This article reports a survey of workplace violence in Hong Kong. A sizable number of the 1,198 organizations that were questioned reported that they had experienced such violence over the 2 years preceding the study, but the problem was not prevalent. In both the private and government sectors, nonphysical violence happened more frequently than physical violence, and there was a reported lack of preparedness of many organizations to deal with the violence. Compared with private organizations, government organizations experienced more coworker and customer violence, but more private than government organizations believed that workplace violence caused the loss of key employees and clients. Correlation analysis found that a subculture of workplace violence appears to emerge over time, such that the more customer violence is experienced, the more is coworker violence, and the more the nonphysical violence, the more the physical violence. These findings are discussed with reference to international findings.

Workplace violence: an overview of patterns of risk and the emotional/stress consequences on targets.

Violence at work (VAW) is a frequent precursor to mental ill health, and to a lesser degree physical injury, among those exposed to this occupational hazard. In this paper an overview is provided of the nature and prevalence of such violence, of the risk factors involved, and of the impact upon victims. The paper examines the definition of VAW which includes both physical and psychological violence. Attention is given to the influential involvement of the UN affiliated International Labour Organisation in setting benchmarks for defining, preventing and responding to VAW. Evidence about the incidence and severity of VAW on a global basis is examined. It is noted that the reliability of information about VAW is quite variable, especially in non-industrialised countries. The available evidence indicates that psychological aggression is widespread across all sectors of employment and physical violence, although far less common, remains a significant problem. Risks of becoming a victim of VAW vary according to numbers of factors including job category, the nature of the work being performed, gender, age and experience. The paper also focuses on research regarding the effects upon persons experiencing or witnessing VAW. This research indicates that the health related consequences of psychological violence can be as severe as those from physical violence. The paper concludes that VAW is a major occupational health and safety hazard in all nations, regardless of their state of development. A reduction or elimination of this violence, and the health problems it creates, requires concerted and integrated strategies, together with rigorous evaluation of preventive measures.

Violence in the workplace.

The challenge for health authorities is to implement effective preventive strategies and a zero-tolerance policy.