Ethical thinking is an indispensable component of sound professional practice across all areas of applied psychology. Within it, practitioners seek to take account of both the principles formulated in codes of conduct and the rights of all the involved participants. In this chapter we first describe the background to and the fundamental concepts of normative ethics before examining the agreed practical ethical principles that determine standards of work and the processes of ethically aware decision making. We identify the major sources of philosophical thought that have influenced the development of professional codes of practice. Examining the implications of this in a variety of contexts in forensic psychology, we focus on the most frequently encountered moral dilemmas and challenges that arise. They are drawn from the areas of working with clients, professional supervision, and research; and involve issues such as the protection of confidentiality, avoidance of role conflicts, resolution of the sometimesincongruent priorities of individual and public domains, and management of boundaries in professional relationships.

The comprehensive biopsychosocial approach to violence requires and enables us to ensure the role of social structures is incorporated in explanations of violence and approaches to addressing the problem. Tackling these social formations requires a public health approach which combines many of the interventions we have considered so far but in addition is designed to do so in an integrated programme which coordinates interventions at different levels. There has been significant growth in these integrated interventions over the past twenty years, especially with vulnerable groups in low- and middle-income countries, and we will consider some examples in this chapter. They are integrated in the sense that they often consist of ‘bundles’ of discrete intervention packages (Yount et al., 2017) operating at distinct levels within and between individuals and across whole societies to tackle violent behaviour both directly and indirectly. These programmes often combine primary prevention through broad structural changes with more direct and focussed interventions with high-risk groups. They may aim, for instance, to equip vulnerable women with the skills necessary to assertively set limits when they are exposed to violent behaviour by their partner. At the same time, they may aim to enhance the status of the same women through providing economic resources which empower them more generally in their relationships with men. The same programmes may also be designed to work with the perpetrators to change both their approach to negotiating with their partner in conflict situations and to change their attitudes toward women more generally. So these integrated programmes operate both on violence itself directly and, for example, on gender relations as an indirect factor associated with premature death from violence and from other avoidable causes such as HIV/AIDS.

Effective risk assessment, when it occurs, ideally leads to decisions about effective interventions. The multifactorial nature of violence, with its origins in biological, psychological, and social processes operating separately or together, means that interventions at all of these different levels are available for those who present an identifiable violence risk. The challenge is to identify which intervention, or combination of interventions, is most suitable in each case and to find the necessary resources for successful implementation. The next three chapters will consider interventions at each of the levels and examine some of the evidence currently available with regard to their effectiveness. In public health terms, the medical and psychosocial interventions to be considered, respectively, here and in the next chapter, mainly represent tertiary but also some secondary prevention efforts deployed with at-risk populations, or with relatively high-risk individuals who have already acted violently. In contrast, the integrated interventions considered in Chapter 10 often incorporate a primary prevention element in addition, as part of a truly comprehensive approach to the problem.

Pharmacology clearly has its limitations and dangers as a tool for reducing violence, especially as part of a public health approach which casts its net so widely across many groups who are viewed as more or less challenging for society. Since it is clear from much of the evidence discussed in Part I of this book that many other factors beyond biology contribute to the tendencies some people have toward violence, it is vital to consider what psychological and social options are available with the potential to counter that tendency. These can be much more expensive to implement because of the need for greater human resources, and, however great the leverage, the intervention can ultimately be refused or ignored. In addition, they are often more difficult to test in terms of efficacy for reasons similar to those discussed in the previous chapter. However, it is psychosocial interventions which the WHO approach endorses most strongly in its ‘best buy’ guidance and which therefore need to be examined here in terms of practicality and effectiveness.

Consider the following question. What would be likely to happen if a group of humans was returned to a ‘state of nature’, divested of the elaborate mechanisms of control that we assume restrain our impulses in everyday civilised life? Many people would probably expect that the likeliest result would be a breakdown of order and a resurgence of primeval self-interest, with increasing aggression, possibly spiralling into violence. This is the theme of William Golding’s dystopian novel Lord of the Flies, published in 1954. It is the imagined story of a group of British schoolboys shipwrecked onto a remote oceanic island. While they initially agree a set of rules for communal living, their behaviour soon deteriorates. Factions emerge, and hostilities erupt, followed by ghastly murderous violence. The book became a worldwide best-seller and was later turned into a stage play and several film versions. It was placed on reading lists in schools and colleges in many countries. The story appears to confirm what many people assume: that once the veneer of socialised conduct is stripped away, human beings naturally resort to ‘the law of the jungle’ based on evolutionary survival strategies.

There is general agreement among scientists that biological factors form an essential ingredient of a comprehensive explanation for human violence. As we have already noted, displays of aggression, fighting, and other forms of violent behaviour are easy to find across many species, and it is mostly the case that aggression pays off when survival is at stake, if there are no other means of ensuring it. It is deployed in acquiring and protecting resources, for self-defence and to promote chances of reproductive success. Yet the public health approach in this area often appears to shy away from the issue of biological factors in human violence, especially from the potential role genes might play in a tendency toward such behaviour. One of the WHO’s key statements, the World Report on Violence and Health (Krug et al., 2002), gives only brief consideration to the possible role of genetic biomarkers as risk factors for self-directed violence, but notes that what individuals may inherit is a risk of mental disorder linked to suicide rather than a propensity toward suicide in itself. The subsequent Global Status Report on Violence Prevention (World Health Organization, 2014, p. 27) in contrast acknowledges that ‘violence is a multifaceted problem with biological, psychological, social and environmental roots’. However, neither of these two landmark publications allots any space to detailed consideration of biological processes, and neither mentions genetic factors in relation to violence at all. Both reports depict violence as a problem which encompasses biological as well as the other identified influences. Yet could it be that simultaneously they render genetic influences on human aggression as something of an ‘elephant in the room’? At issue again is the question of whether we consider this strategy to be integral to our biologically evolved makeup, to an extent whereby as humans we are incapable of refraining from it. Can we leave that history to one side in explaining and addressing violence, and is the WHO on secure ground in paying minimal attention to biological influences?