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Published on December 10th, 2014 | from CAMH

Understanding mental illness and violence


By Dr. Sandy Simpson, Chief of Forensic Psychiatry at CAMH

Dr. Sandy SimpsonThere are few issues so misleadingly linked in the public mind as mental illness and violence.

The best efforts of Hollywood, and the media’s tendency to conflate risk and illness in the context of mass shootings in the USA , leaves the public reasonably thinking that people with mental illness present a major risk to the public. They don’t, but this seems counter-intuitive to the public because of all the media images.

So what are the facts? Is there a relationship between mental illness and violence?

The answer is yes, there is a small but significant increase in risk of violence associated with serious mental illness. But only for one type of mental illness, and only at a particular time during the illness. Let’s tease that apart.

Most mental illnesses have no relationship with offending. The mental illness that does increase the risk of violence is psychotic illness. Even so, most people with a psychotic illness present no increased risk to others. And those that do only do so when they are ill.

The contribution to all offending in our community that can be attributed to psychosis is approximately 4%. So even though psychosis increases risk, it contributes only a small amount to all the violence in our communities.

Psychotic illnesses are relapsing disorders, and the severity of the symptoms of illness varies greatly. During acute episodes of psychosis, symptoms such as delusions, hallucinations and disturbed and distressed emotions become heightened. It is during that phase of the illness that the person can present a greater risk to others.

What leads to such severe symptoms and how best are we to help people who suffer these acute episodes of illness?
For a variety of reasons, but often related to issues of stigma and uncertainty about whether services will help in the right way,  people suffering psychotic illnesses may delay getting care. This delay worsens the severity of their illness and increases the risks to the person themselves, and to others.

The best way we can respond as a community is by striving to decrease the stigma surrounding having an illness, increasing initiatives of social inclusion, encouraging people to get care, making resources more readily available, and delivering high quality recovery-based services.

In summary, yes there is a relationship between psychosis illness and violence — but most people with psychotic illness, most of the time, present no increased risk to others. Good care and socially-inclusive societies are our best ‘protection’ against the problem of violence arising from psychotic illness. We must strive to overcome fear, stigma and isolation.

There are other complexities involved in understanding and tackling these issues which I will address in later blogs, including:

  • how do we help people with problems of drug use as well and mental illness [all too common and very difficult problems also]?
  • how do we help people whose illness interferes with their ability to realize they need help, or reject the care we can offer?
  • how can we prevent people with mental illness becoming involved with the criminal justice system?

Continue the conversation – comment below or follow Dr. Sandy Simpson on Twitter: @DrSandySimpson

Image courtesy of Ryan Melaugh on Flickr

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2 Responses to Understanding mental illness and violence

  1. annick says:

    Looking forward to Dr.Simpson’s next blog..and hoping that an examination of the Mental Health Act may be suggested by a blogger..
    Could it be that the pendulum swung just a lttle bit too far ?

  2. Joe Meyer says:

    This is well-stated and accurate. I’d like to add that although psychotic illnesses represent a tiny percentage of psychiatric illnesses, and people with such illnesses are only at an increased risk of violence when unstable, the risk of violence is a genuine concern for family and friends of those with psychotic disorders. This is one reason why we believe that access to timely and effective treatment is particularly important for those with such disorders. This is why we think those with these most serious of psychiatric disorders should go to the front of the line when treatment is needed.

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