General Resources / Legal Resources / Medical Resources / Briefing Papers / State Activity    
Hospital Closures / Preventable Tragedies / Press Room / Search Our Site / Home

 

Briefing Paper

Updated April 2007

Download a printable PDF file


Violent behavior: One of the consequences of failing to treat individuals with severe psychiatric disorders

SUMMARY: It is well known that the two major demographic predictors of violent behavior are male sex and younger age. It is also known that the two major clinical predictors of violent behavior are past history of violence and substance abuse (alcohol and/or drug). Recent studies have established that being severely mentally ill and not taking medication is a third major clinical predictor of violent behavior.

* * *

  1. Severely mentally ill individuals who ARE taking their medication are NOT more dangerous than the general population.

Steadman HJ, Mulvey EP, Monahan J, et. al. Violence by people discharged from acute psychiatric impatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55:393–401, 1998.

  1. Severely mentally ill individuals who are NOT taking their medication ARE more dangerous than the general population.
     

Sosowsky, L. Explaining the increased arrest rate among mental patients: A cautionary note. American Journal of Psychiatry 137:1602–1605, 1980.

Grunberg F, Klinger BI, Grumet BR. Homicide and community-based psychiatry. Journal of Nervous and Mental Disease 166:868–874, 1978.

Rabkin J. Criminal behavior of discharged mental patients: A critical appraisal of the research. Psychological Bulletin 86:1–-27, 1979.

Swanson JW, Hozer CD, Ganju VK, et. al. Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry 41:761–770, 1990.

Swanson J, Estroff S, Swartz M, et. al. Violence and severe mental disorder in clinical and community populations: The effects of psychotic symptoms, comorbidity, and lack of treatment. Psychiatry 60:1–22, 1997.

Yesavage, J.A. Inpatient violence and the schizophrenic patient: An inverse correlation between danger-related events and neuroleptic levels. Biological Psychiatry 17:1331–-1337, 1982.

Smith LD. Medication refusal and the rehospitalized mentally ill inmate. Hospital and Community Psychiatry 40:491–496, 1989.

Taylor P. Motives for offending amongst violent and psychotic men. British Journal of Psychiatry 147:491–498, 1985.

Steinwachs DM, Kasper JD, Skinner EA. Family perspectives on meeting the needs for care of severely mentally ill relatives: A national survey. Arlington, VA: National Alliance for the Mentally Ill, 1992.

Shore D, Filson CR, Rae DS. Violent crime arrest rates of White House case subjects and matched control subjects. American Journal of Psychiatry 147:746–750, 1990.

Bartels J, Drake RE, Wallach MA, et. al. Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin 17:163–171, 1991.

Lindqvist P, Allebeck P. Schizophrenia and crime: A longitudinal follow-up of 644 schizophrenics in Stockholm. British Journal of Psychiatry 157:345–350, 1990.

Hodgins, S. Mental disorder, intellectual deficiency, and crime. Archives of General Psychiatry 49:476–483, 1992.

Monahan J. Mental disorder and violent behavior. American Psychologist 47:511–-521, 1992.

Martell DA, Dietz PE. Mentally disordered offenders who push or attempt to push victims onto subway tracks in New York City. Archives of General Psychiatry 49:472–475, 1992.

Link BG, Andrews H, Cullen FT. The violent and illegal behavior of mental patients reconsidered. American Sociological Review 57:275–292, 1992.

Wesseley SC, Castle D, Douglas AJ, et. al. The criminal careers of incident cases of schizophrenia. Psychological Medicine 24, 483-502, 1994.

Kasper JA, Hoge SK, Feucht-Haviar T, et. al. Prospective study of patients’ refusal of antipsychotic medication under a physician discretion review procedure. American Journal of Psychiatry 154:483–489, 1997.

Modestin J, Ammann R. Mental disorder and criminality: Male schizophrenia. Schizophrenia Bulletin 22: 69–82, 1996.

Eronen M, Tiihonen J, Hakola P. Schizophrenia and homicidal behavior. Schizophrenia Bulletin 22:83–89, 1996.

Rasanen P, Tiihonen J, Isohanni M, et.al. Schizophrenia, alcohol abuse, and violent behavior: a 26-year follow-up study of an unselected birth cohort. Schizophrenia Bulletin 24:437–441, 1998.

Steadman HJ, Mulvey EP, Monahan J, et. al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55:393–401, 1998.

Taylor PJ, Leese M, Williams D, et. al. Mental disorder and violence. British Journal of Psychiatry 172:218–226, 1998.

Belfrage H. A ten-year follow-up of criminality in Stockholm mental patients. British Journal of Criminology 38:145–155, 1998.

Swartz MS, Swanson JW, Hiday VA, et. al. Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry 155:226–231, 1998.

Swanson JW, Swartz MS, Essock SM et al. The social-environmental context of violent behavior in persons treated for severe mental illness. American Journal of Public Health 92:1523–1531, 2002.

Arango C, Barba AC, Gonzalez-Salvador T, et. al. Violence in schizophrenic inpatients: A prospective study. Schizophrenia Bulletin, 25:493–503,1999.

Friedman L, Hrouda D, Noffsinger S et. al. Psychometric relationships of insight in patients with schizophrenia who commit violent acts. Schizophrenia Research 60:81, 2003.

Alia-Klein N. Violence and psychosis in relationship to insight into illness and medication compliance. Submitted for publication.

Arseneault L, Moffitt TE, Caspi A et. al. Mental disorders and violence in a total birth cohort. Archives of General Psychiatry 57:979-986, 2000.

Monahan J. Mental disorder and violent behavior. American Psychologist 47:511–521,1992.

Marzuk PM. Violence, crime, and mental illness. Archives of General Psychiatry 53:481–486, 1996.

Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence. British Journal of Psychiatry 180: 490–495, 2001.

  1. Individuals with severe mental illnesses probably are responsible for approximately 5 percent of violent episodes, including homicides in the United States.

Monahan J. Mental illness and violent crime. National Institute of Justice Research Preview, October 1996.

Dawson JM, Langan PA. Murder in families. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 1994.

Wilcox DE. The relationship of mental illness to homicide. American Journal of Forensic Psychiatry 6:3–15, 1985.

 

Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence. British Journal of Psychiatry 180: 490–495, 2001.

  1. At least 10 percent of males with severe mental illnesses become violent and a lesser percentage of females. In the United States, this would total approximately 200,000–250,000 individuals.
     

Hodgins S, Mednick SA, Brennan PA, et.al. Mental disorder and crime. Archives of General Psychiatry 53:489–496, 1996.

  1. Publicized episodes of violence by individuals with severe mental illnesses are a major cause of discrimination and stigma against this group.

Angermeyer MC, Matschinger H. The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill. Social Science and Medicine 43:12:1721–1728, 1996.

Thorton JA, Wahl OF. Impact of a newspaper article on attitudes toward mental illness. Journal of Community Psychology 24:17–25, 1996.

"Recent research data on contemporary populations of ex-mental patients supports these public fears [of dangerousness] to an extent rarely acknowledged by mental health professionals. . . .It is [therefore] futile and inappropriate to badger the news and entertainment media with appeals to help destigmatize the mentally ill."

Steadman, HJ. Critically reassessing the accuracy of public perceptions of the dangerousness of the mentally ill. Journal of Health and Social Behavior 22. 31–316, 1981.

"The data suggest that public education programs by advocates for the mentally disordered along the lines of ‘people with mental illness are no more violent than the rest of us’ may be doomed to failure….And they should: the claim, it turns out, may well be untrue."

Monahan J. Mental disorder and violent behavior. American Psychologist 47:511–521, 1992.

See the briefing paper "Stigma and Violence" for a fuller discussion of this issue.

 


general resources | legal resources | medical resources | briefing papers | state activity   
hospital closures | preventable tragedies | press room | search | home

FootnoteImage2.jpg (1088 bytes)
Treatment Advocacy Center

The contents of TAC's website are copyrighted by the Treatment Advocacy Center unless otherwise indicated. All rights reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes only, if correct attribution is made. TAC is an I.R.C. � 501(c)(3) tax-exempt corporation. Donations are appreciated and are eligible for the charitable contribution deduction under the provisions of I.R.C. � 170. Please note that TAC does not accept funding from pharmaceutical companies or entities involved in the sale, marketing, or distribution of such products.

Treatment Advocacy Center (TAC), 200 N. Glebe Road, Suite 730, Arlington, VA 22203
703 294 6001/6002 (phone) | 703 294 6010 (fax) | www.treatmentadvocacycenter.org (website)
[email protected] (general email) | [email protected] (press contact)
[email protected] (webmaster)