Violence & Mental Illness

1. Violence & Mental Illness Facts & Myths Adapted from Yale Forensic Training Program (Norko, MD & Baranoski, PhD 1998)

2. Historical Association Between Dangerousness & Mental Illness • Literature on violence and mental illness dates back to ancient Greek & Roman texts • Religious doctrine reified link between aberrant behavior & evil (Dominican monks-hunting and disposing of witches, priests exorcising evil spirits) • Advent of Lunatic Asylums-to segregate mentally ill (“protect public”)- not treat • First 2 psychiatric “hospitals” in America were funded on premise of “danger” of mentally ill

3. Historical Association continued… • Endorsement of “Animalism” as theory of madness- mentally ill are like animals • 1843 first acquittal in murder case for the idea of mental defect (paranoid schizophrenia) • Media blitz of sensational cases (attempted assassin of Reagan, Jessica Short, Uni-bomber) • Movies & TV characters 73% mentally ill portrayed as violent, 23% homicidal -- vs – 40% normal portrayed as violent, 10% as homicidal

4. Enduring Public Perception • There is a strong correlation between mental illness and violence Random targets Unpredictable behavior • Societal discomfort with psychiatric illness • Stigma of mental illness Loss of control Dependency and failure Diabolical & evil • Irrational fear

5. Facts • Statistics (Swanson, Holzer, Gangu et al, 1990) No disorder- 2% risk of violence in past year Major Mental Disorder -11-13% risk of violence in past year Alcohol Abuse -25% risk of violence in the past year Drug Abuse – 35% risk of violence in the past year • Prevalence of alcohol abuse is approximately 13% in U.S. whereas prevalence of schizophrenia is 1% Therefore substance abuse creates a greater risk to society as the risk of assault is 20 times greater for individual abusing alcohol than and individual with schizophrenia.

6. Facts continued… • Patients who begin substance abuse before the age of 15 are statistically more likely to become violent after onset of mental illness. • Highest prediction of violence is when delusional thinking is co-occurring with substance abuse. Mental Illness alone is poor predictor of violence. (Grossman, Frobes, Ruthazer, 1997; Link 1994) • Violence predicted by 3 specific active psychotic sxs Delusions that someone is doing the individual harm Delusions that the individual is being controlled by others Delusions of thought insertion • Past psychosis is NOT related to risk

7. Dynamics of Violence VIOLENCE Individual Factors Situational Factors Temporal Management

8. Individual Factors • Psychiatric – Active sxs Command hallucinations Persecutory delusions Severe Depression (self-violence-suicide) • Anti-social personality • Frontal lobe injury (impulsivity) • Previous exposure to violence • Substance abuse • Response to and compliance with treatment

9. Situational Factors • Size, strength, and health of potential victim • Availability of weapons • Substances (what, frequency, effect) • Presence of authority figure • Living/ residential setting

10. Temporal Factors • Special events • Selected times of year (increased isolation, increased publicity about specific events) • Availability of treatement • Recency of high profile incidents

11. Management Factors • Availability of services • Adequacy of reporting behaviors/ observations • Clear policy and procedures for identifying and mediating risk • Family or other supportive service involvement