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Are Former Mental Patients Violent?

Leonard Holmes, Ph.D.                       http://mentalhealth.about.com

Our society (at least in the U.S.) continues to stigmatize mental illness.  Mental patients and former mental patients are viewed with caution.  Highly publicized cases of violence such as "the Unibomber" has resulted in a connection between mental illness and violence in the minds of millions.   Are former mental patients really more violent than the general population?  A recent study sheds light on this issue. 

Henry J. Steadman, Ph.D. and his colleagues followed about 1,136 former psychiatric patients from Pittsburgh, Worcester, Mass., and Kansas City, Mo. between the ages of 18 and 40 for one year after discharge.   Interviews were conducted every 10 weeks with the patient and at least one person who was most familiar with their behavior in the community. A group of 519 Pittsburgh residents who had not been hospitalized and were culled from the neighborhoods to which the ex-patients returned served as a control group.

The study's results and conclusions are reprinted below from the paper's abstract:

  • Results:
    There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home.
  • Conclusions:
    "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.
    (Steadman, et. al, 1998)

A Washington Post article describing the study quotes psychiatrist E. Fuller Torrey - president of the Treatment Advocacy Center of the National Alliance for the Mentally Ill (NAMI) - as saying "It's what we've suspected: that if you treat people with serious mental illness they become less violent."  The article then states that he "speculated that the study might underestimate the danger some patients pose because it did not include those who are homeless, in jail, or ordered into treatment after criminal, rather than civil, proceedings." (washingtonpost.com, 1998 - article no longer at its previous online location)

The prediction of dangerousness in a given individual has always been difficult.  The best predictor of future dangerousness is past violent behavior.  This new study suggests that a history of substance abuse can also be used as a legitimate factor in attempting to predict violence.  

Reference: Steadman, H.J., Mulvey, E.P., Monahan, J., Robbins, P., Appelbaum, P.S., Grisso, T., Roth, L., & Silver, E. (1998) Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods.  Archives of General Psychiatry, May 1998

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Leonard Holmes, Ph.D.                       http://mentalhealth.about.com

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