most people have little reason to fear violence from people with mental illness, even in its most severe forms.
historically, in the 1950s, mental illness carried great social stigma, especially linked with fear of unpredictable and violent behaviour. while there is greater public understanding of mental illness nowadays, paradoxically, the perception of people with psychosis as being dangerous is stronger today than in the past.
so why is fear of violence so entrenched? most speculations focus on media coverage and deinstitutionalization. one series of surveys found that selective media reporting reinforced the public’s stereotypes linking violence and mental illness and encouraged people to distance themselves from those with mental disorders. fortunately, negative perceptions about severe mental illness can be lowered by furnishing empirically based information on the association between violence and severe mental illness.
indeed, people with a mental illness are 2.5 more likely to be the victims of violence than other members of society. this tends to happen when poverty, a transient lifestyle or substance use are present. any of these factors make a person with mental illness more vulnerable to assault and the possibility of becoming violent in response.
however, mental illness plays no part in the majority of violent crimes. alcohol and substance abuse far outweigh mental illness in contributing to violence. a 1996 health canada review found that the strongest predictor of violence and criminal behaviour is not major mental illness, but past history of violence and criminality.
on rare occasions, people with mental illness who feel threatened and/or whose symptoms override personal control can behave violently. this can happen with command hallucinations or feeling that one’s mind is being dominated by outside forces. such symptoms and behaviour tend to occur more often when the person is off their medication.
living in a stressful, unpredictable environment with little family or community support can also contribute to occasional violent behaviour by individuals suffering from psychosis or neurological impairment.
patterns of violence are similar regardless of a person’s mental health status. for example, people with a mental illness are no more likely than anyone else to harm strangers. violent behaviour by anyone is generally aimed at family and friends, rather than strangers, and it typically happens in the home, not in public.
most of this violence is committed by men and directed to women. the risk for family violence is, among others, also related to low socioeconomic status, social stress, social isolation, poor self esteem and personality problems.
the major predictors of violence, regardless of mental health status, are being young, male, of lower socio-economic status, and abusing alcohol or drugs. substance disorders are major contributors to community violence, perhaps accounting for as much as a third of self-reported violent acts, and seven out of every 10 crimes of violence among mentally disordered offenders.
too much past research has focussed on the person with the mental illness, rather than the nature of the social interchange that led up to the violence. therefore, we do not know enough about the nature of these relationships and the context of violence, and much less than we should about opportunities for primary prevention.
here in canada, a senate committee has released a report on mental health, mental illness and addiction. while it was generally applauded, there was considerable concern that the report is “gender blind” and silent on the issue of violence against girls and women, which has a significant and well-documented impact on long-term physical and mental health.
(this post made the list of the surfers paradise hullabaloo)