Though violence does occur in people with psychiatric illness, it is not, however, Violence & mental illness does not go hand in hand. National/Population survey suggests that most people believe that individuals with psychiatric illness are more violent than the general population.
Data from the Natural comorbidity survey 2005, states that rates of violence in adults with psychiatric illness is two to eight times more than that of the general population.
People with a diagnosis of Anxiety and depression have an almost similar risk as that of the general population (two to three times)
People with Bipolar disorder or drug and alcohol use disorder are eight times more likely to report violent behaviors than the general population.
It concluded that demographics factors like ethnicity and gender are better predictors of violent behavior than psychiatric diagnosis.
It had similar findings with the conclusions of the 1996 Consensus Statement by Advocates and Researchers on violence and mental illness: “mental illness is only a weak predictor of violent behavior.”
Steadman et al, 1998 Concluded that there is no difference in the risk of violence in treated patients with a psychiatric disorder and people without a psychiatric disorder.
More recent studies suggest that the Attributed risk of violence due to serious mental illness is about 3–5%
Factors that contribute to violence in individuals with serious psychiatric illness include Demographic, Clinical, Historical, and social factors.
-Demographic factors include Gender with males, more than females.
Age: late teens and early twenties are usually associated with increased risk.
-Clinical factors: Untreated and actively symptomatic individuals with serious psychiatric illness are at higher risk of violent behavior. Of note untreated psychosis especially those with persecutory delusions are more likely to carry out well-planned violent acts that are consistent with the delusions. Compliance with command auditory hallucinations that are violent. Cognitive challenges brought on by major neurocognitive disorder or intellectual disability may also predispose to increased risk as delusions and impulsivity are common.
Substance use including alcohol carries a significant risk of violent behavior especially when it co-occurs with a psychiatric diagnosis.
-Social factors: Unemployment, poor education, residential instability, poor neighborhood, child abuse, Recent divorce, and juvenile arrests/parental arrests.
-Historical factors: The history of violence is usually considered the best predictor of violence in the future. History of victimization, History of criminality. Persons with antisocial personality traits/disorders.
Addressing the modifiable factors can mitigate the risk of violence encountered in mental health.
This will include identifying those that are clinically unstable like those with untreated active psychosis, a history of non-compliant with medications, and those with co-occurring substances. Voluntary and involuntary hospitalization may be necessary.
Engaging in substance abuse treatment, vocational engagement and mitigating residential challenges are extremely important.
Clinicians should be aware that some of their patients may pose a higher risk of violence especially when untreated.
It must be noted that most people who commit violent acts are not mentally ill.
Also, check out Mental health disorders in children and how it can be handled.
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