Violence and mental illness

It is hard to focus on the facts about mental illness and violence when the news is peppered with horror stories making one think that mental illness and violence go hand- in- hand. Nothing is further from the truth. The incidence of violence committed by someone with a mental illness is the same as the incidence of violence committed by the general population: about one percent of the population. In fact, a person with mental illness is more likely to have an act of violence perpetrated on them. Let’s look at some facts as enumerated in the NAMI Family-to-Family Education Program, 2013.

• People with schizophrenia and mania who take medication regularly and who do not abuse alcohol or other drugs are no more violent that the rest of the population. Most people with schizophrenia are customarily withdrawn, frightened and passive.
• Similar to the general population, people with untreated schizophrenia and mania are more liable to commit a violent act if they are on street drugs (crack, meth, cocaine, speed, PCP-even marijuana) or if they are abusing alcohol. The use of street drugs or alcohol increases the likelihood that the untreated individual may act on the violent thoughts and paranoid delusions they are having. The combination of major mental illness and substance abuse is a significant predictor of aggressive behavior.
• The likelihood of violence is greatest among males in their late teens or early 20’s.
• The best prediction of future behavior is past behavior. There is good reason to be wary of an individual who was aggressive before becoming ill, or of individuals who have previously been violent when they were particularly disturbed. If your relative has never been aggressive in a period of psychosis, it is unlikely that s/he will become so.
• Warning signs of imminent physical violence that inpatient staff in psychiatric facilities are taught to look for are as follows: impulsivity, talking more about violent ideas, a sudden change in eye contact (staring or avoiding looking others in the eye), pacing, becoming visible angry, yelling, tremors, a rigid posture, clenching jaws and fists, pulsing arteries in the temples, verbal abuse, profanity, and hyperactivity.
• Besides our concern about aggression, we all deal with our dread that our family members will do something harmful to themselves. Some people, especially those with more insight into the damage caused by their illness, may become depressed after a psychotic or manic episode. Many families struggle through the active phase of schizophrenia or intense mood episodes only to be stunned by a family member’s suicide attempt when they felt that things were getting better. Even if these critical events don’t happen in our experience, it is important to know about them. If you have an opportunity to spread the truth about violence and mental illness, you can reduce stigma.