(Nov. 14, 2017) More than 15 years have passed since the MacArthur Violence Risk Assessment Survey found that individuals with serious mental illness are much more likely to be violently victimized than commit acts of violence against others.
However, the results of the 2001 study are still the go-to source for the connection between serious mental illness and violence. The survey found that after one year post-discharge from a psychiatric hospital, 43% of individuals had experienced some form of violent victimization, while only 28% had committed an act of violence against others. In addition, the results indicated that 23% of individuals had committed acts of violence towards one self.
John Monahan and colleagues, the authors of the original MacArthur survey results, recently reexamined the MacArthur findings to study the overlap of the three forms of violence in individuals with serious mental illness: violent victimization, violence towards one self and violence against others.
Individuals with schizophrenia and bipolar disorder were less likely to have experienced any form of violence compared to other individuals in the group, which included people with depression and substance use and alcohol disorders, according to the report. However, individuals with serious mental illness who had co-occurring substance use disorder were more likely to have experienced at least one form of violence. The results show that these individuals also constituted the majority of the group that experienced all three forms of violence.
Violence risk assessment findings
The findings of the study are following. For individuals in the survey,
- 58% experienced at least one form of violence,
- 28% experienced at least two forms of violence and
- 7% experienced all three forms of violence: violent victimization, violence against one self and violence against others.
The authors concluded that the high prevalence of multiple forms of violence experienced by individuals recently discharged from a psychiatric hospital suggests that clinicians should screen for multiple types of violence and consider the experience of all forms of violence in treatment decisions.
Victimization behind bars
Victimization of individuals with serious mental illness in jail and prison occurs even more frequently with prevalence rates ranging from 4-31% depending on the study. A 2013 Bureau of Justice Statistics report states that individuals with serious psychological distress have significantly higher rates of sexual victimization than inmates with no mental illness.
Individuals with serious mental illness in prison were nine times more likely to report that they were sexually victimized by another inmate than individuals with no mental illness. Although sexual victimization is less prevalent among jail inmates with mental illness, it is five times higher than the 0.7% prevalence among individuals in jail with no mental illness.
Evidentiary solutions
Marvin Schwartz, a researcher from Duke University, studies the risk of violence and victimization for individuals with serious mental illness. A 2002 article written by Schwartz and colleagues reports that outpatient commitment, such as assisted outpatient treatment (AOT), can reduce the risk of victimization among individuals with serious mental illness. This effect is mediated through improved medication adherence and reduced substance use, according to the study authors.
Scwartz wrote in a January 2017 World Psychiatry article:
A colleague likes to say that an alien visiting the US from outer space, after watching a few hours of television, would surely conclude that persons with severe mental illness perpetually perch on the cusp of violence and mass mayhem. Media accounts in the US portray such persons as if their greatest risk of violence is towards others, and the risk of violent victimization of trivial concern. It is hard for the general public and even many clinicians to acknowledge that this simply is not so.
The authors conclude that prevention of victimization must start with assertive mental health treatment. Connection to both mental health and substance use services is key to combat this public health problem.
Elizabeth Sinclair
Research Associate
References:
- Monahan, J. et al. (May 2017). Violence to others, violent self-victimization, and violent victimization by others among persons with a mental illness. Psychiatric Services.
- Hiday, V. A. et al. (2002). Impact of outpatient commitment on victimization of people with severe mental illness. American Journal of Psychiatry.
- Schwartz, M. S. et al. (January 2017). Victimization of persons with severe mental illness: a pressing global health problem. World Psychiatry.