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Mental Illness & Violence

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Review the best evidence concerning relationships between mental illness and physical violence in the US and other Western countries in recent decades, including violence against others by people with mental illness; violence against people with mental illness (including both violence by others and suicide); and evidence-based approaches to reducing these problems.

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Mental Illness & Violence

  1. 1. Created May 2014, Revised September 2020 Mental Illness and Violence – What does the evidence tell us? Presented by NAMI Main Line PA, an affiliate of the National Alliance on Mental Illness NAMI Main Line PA Copyright, 2014, Ingrid Waldron 1 by Ingrid Waldron, President, May 4, 2014
  2. 2. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 2 Introduction • Review best evidence concerning relationships between mental illness and physical violence in the US and other Western countries in recent decades, including: – violence against others by people with mental illness – violence against people with mental illness (including both violence by others and suicide) – evidence-based approaches to reducing these problems
  3. 3. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 3 • For this discussion, major mental illness includes: – Schizophrenia and other psychoses (which includes delusions, hearing voices and hallucinations) – Bipolar disorder – Depression and anxiety disorders – Personality disorders (e.g. antisocial personality disorder or borderline personality disorder)
  4. 4. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 4 People with major mental illness are more likely to commit violence against others. • People with major mental illness are ~2-6 times more likely than the general public to commit violence. • ~ Half of the victims are intimate partners or other family members. • Only ~15% of the victims are strangers.
  5. 5. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 5 But most people with major mental illness are not violent. Only a small proportion of total violence is committed by people with major mental illness. • Only ~5-15% of people who have major mental illness were violent in the past year. • Only ~5-15% of violence is committed by people who have major mental illness.
  6. 6. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 6 The risk of committing violence against others varies, depending on the person’s characteristics. For example, people with schizophrenia and other psychoses are ~3-4 times more likely to commit violence, but risk of violence is much lower if: – no previous history of violence – no substance abuse or dependence –in treatment and compliant with treatment.
  7. 7. Variation, continued In this US population sample, people with major mental illness, but not substance abuse/dependence or a previous history of committing violence, did not have elevated rates of violence over the next three years. People who had major mental illness plus substance abuse or dependence and/or a history of previous violence had increased rates of future violence. History of previous violence was a much stronger predictor of future violence than major mental illness. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 7
  8. 8. Suggests Complex Causal Pathways e.g. Mental Illness self-medicating symptoms Substance Abuse disinhibition + more often in situations where violence is common Increased Risk of Violence NAMI Main Line PA Copyright, 2014, Ingrid Waldron 8
  9. 9. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 9 Homicide • ~10-20% of homicides are committed by people with major mental illness. • For multiple victim homicides in public locations, it appears that at least half are committed by people with major mental illness. These get much media attention, but they account for only ~one in a thousand of all homicide deaths.
  10. 10. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 10 People with major mental illness are more likely than others to be victims of violence. • People with major mental illness are ~3-10 times more likely than the general public to report being a victim of violence. • People with major mental illness are ~3-7 times more likely to be a victim of homicide. • ~15-35% of people with major mental illness report being a victim of violence in the past year.
  11. 11. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 11 Victimization, continued • There appear to be several reasons why people with major mental illness more often are victims of violence. • People with major mental illness are more likely to be unemployed and to have very low income, so they are more likely to be homeless and/or live in dangerous neighborhoods. • Some people with major mental illness are less aware of safety risks and how to avoid them.
  12. 12. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 12 People with major mental illness are more likely than others to commit suicide. • People with major mental illness have ~5-15 times higher risk of suicide than the general public. • 60-70% of suicides are committed by people with major mental illness.
  13. 13. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 13 Mental Illness and Violence – What can we do? Research evidence supports several approaches.
  14. 14. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 14 Evidence-based Approaches to Suicide Prevention • Most effective approach = educating primary care physicians to recognize and treat depression and suicidality (decreases suicide rates by 22-73%). • Second most effective approach = restriction of access to guns and other highly lethal means of committing suicide (decreases suicide by 2-33%).
  15. 15. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 15 Evidence-based gun control Restriction of access to guns should target people who have characteristics known to be associated with high risk for violence during time periods known to be high-risk for violence. This includes: – anyone convicted of a violent crime – anyone subject to a domestic violence restraining order – anyone with a recent conviction related to drug or alcohol abuse – anyone recently released from involuntary hospitalization for mental illness and deemed dangerous to self or others
  16. 16. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 16 Preventing Violence Against Others and Violent Victimization • Preventive court-ordered outpatient treatment combined with better access to good mental health services appears to reduce violence against others and violent victimization for people with major mental illness. • Much more information is needed about effective treatments, including treatment for substance abuse in combination with mental illness and the role of services such as safe housing.
  17. 17. Mental Illness, Stigma and Violence Violence by people with mental illness (especially as exaggerated in entertainment and news media) Increased stigma against individuals with mental illness Contributes to avoiding treatment and probably also inadequate funding for needed treatment + less access to good jobs and housing Greater risk of violence by people with mental illness NAMI Main Line PA Copyright, 2014, Ingrid Waldron 17
  18. 18. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 18 Additional Resources • For information and help for someone with major mental illness, contact – NAMI (National Alliance on Mental Illness) http://nami.org/, 800-950-6264 – NAMI Main Line PA, NAMIMainLinePA.org, info@NAMIMainLinePA.org, 267-251-6240 • For information and help for someone with substance abuse, go to www.helpguide.org/topics/addiction.htm
  19. 19. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 19 Avoiding Violence in Your Home • If a family member or friend with mental illness threatens violence, helpful advice to avoid violence is available. • Advice for getting a person with mental illness help that can prevent a mental health crisis from escalating to threats of violence is available (see e. g. Communicating with a Loved One Who Has a Mental Illness and Help Guides).
  20. 20. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 20 Preventing & Coping with Suicide If you or a family member or friend is at risk for suicide, helpful advice at HelpGuide and Mental Health First Aid. Coping with the aftermath of a suicide
  21. 21. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 21 Handling a Crisis • Suggestions from the Treatment Advocacy Center for getting help in an assault crisis • Resources from NAMI Main Line PA, for crisis preparation & prevention
  22. 22. Presented by NAMI PA, Main Line an affiliate of the National Alliance on Mental Illness www.NAMIMainLinePA.org info@NAMIMainLinePA.org See the full YouTube presentation here. NAMI Main Line PA Copyright, 2014, Ingrid Waldron 22

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