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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

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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

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• 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)

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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.

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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.

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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.

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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.
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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
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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.

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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.

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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.

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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.

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Mental Illness and Violence –
What can we do?
Research evidence supports several
approaches.

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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%).

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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

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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.

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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
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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

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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).

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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

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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

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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.
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2014, Ingrid Waldron 22