Letters

Editor:

In a previous Journal article, Dr. John L. Young called for the development of “Ethics Guidelines in a Widened Context,”¹ by citing a National Academy of Sciences report on forensic science as well as responses on the part of the judicial and executive branches of government. He noted the relative absence of a voice on the part of forensic mental health and highlighted that we have something specific to offer: namely, our expertise in psychology and human cognition. I commended him then on prompting us to expand our attention to the discourses that are occurring at national and international levels and suggested that we need more such discussions, especially in the area of violence prevention. With The Global Status Report on Violence Prevention 2014 being prepared by the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC), and the United Nations Development Programme (UNDP), and the 67th World Health Assembly adopting a historic resolution addressing violence,² there was a need for science-based input from around the world; yet, at the key meetings, I was only one of two forensic psychiatrists present.

Different from many other diplomatic or policy-associated areas, the prevention of violence has become a prominent matter for academic involvement. Ever since the publication of the WHO's landmark World Report on Violence and Health,³ violence has increasingly been framed around the world as a major public health concern, not just one of security and criminal justice. Most observers of the field will note how its scope has been growing with greater understanding: the multidetermined nature of violence, be it at the individual, interpersonal, or collective level, points to broader causal dynamics than initially assumed. The greatest predictor of individual violence, for instance, is societal inequities in income and wealth.⁴ The occurrence of wars at a global level has paralleled key points of increase in disparities between rich and poor nations. Even suicide and self-directed violence may become more socially determined as they fluctuate with unemployment levels. Finally, the rates of overt violence are miniscule compared with the excess deaths and disabilities resulting from structural violence,⁵ which operates through unjust social structures or institutions and in turn predisposes to behavioral violence.

These observations, coupled with the increasing emphasis on primary prevention, highlight the importance of good global governance as the ultimate therapeutic jurisprudence. Mental health professionals, especially those with forensic training, may do well to emphasize that violence prevention ultimately depends on good global governance and, one might venture to say, on global mental health. Because of their awareness of scholarship, as well as immediate sensitivity to the human psyche and situation, the cooperation of mental health professionals with policymakers may be as essential as the systematic cooperation between nations. As Dr. Young noted, our field is experiencing rapid progress in the areas of understanding violence risk, the use and applicability of restraints and seclusion, and the management of aggressive behavior, not to mention prevention. There are many areas where the sensitivity and expertise of forensic professionals can be useful, and it would do well to widen our own ethical imperative to participate locally, legally, and politically where governing bodies lack this knowledge and are seeking it.