Date Published: 7 August 2005

Psychiatric Patients more likely to be recent victims of violence than general population

Matters surrounding the causes of, treatment for, and management of mental health issues are frequently featured in British newspapers, magazines and television news channels.
These subjects are usually complex, involving many issues such as the personal health and well-being of the psychiatric patients themselves, public safety, public predjudice, and civil rights concerns about detention of individuals without trial "before" a "likely" offence has been committed.

Recent research at Northwestern University (Chicago, IL) has now raised another related issue - that of violent crime endured by psychiatric patients - either as a consequence of, or contributory factor to, their mental health problems.

The recent study indicates that over one quarter (25%) of individuals with severe mental illness were victims of violent crime in the past year, which is almost 12 times general population rates. The study is published in the August issue of Archives of General Psychiatry.

Summary of Research Findings

Depending on the type of violent crime (rape/sexual assault, robbery and assault), prevalence was six to 23 times greater among persons with severe mental illness than among the general population, said lead author Linda A. Teplin, Owen L. Coon Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine.

In addition, the annual incidence of violent crime in persons with severe mental illness who live in the community is more than four times higher than that in the general population, said Teplin, who is director of the Psycho-Legal Studies Program at Feinberg.

Teplin and her colleagues administered the National Crime Victimization Survey (NCVS) to 936 randomly selected patients from 16 outpatient, day or residential mental health agencies in Chicago, and compared results with those of the 32,450 participants in the annual NCVS conducted by the Bureau of the Census for the Bureau of Justice Statistics.

Research has shown that individuals with mental disorders who live in the community are a vulnerable population at high risk for becoming victims of crime.
Symptoms associated with severe mental illness, such as disorganized thought processes, impulsivity and poor planning and problem solving may compromise one's ability to perceive risks and protect oneself, Teplin and colleagues suggested.

Other factors correlated with victimization, including substance abuse, conflicted social relationships, poverty and homelessness, also are common among persons with severe mental illness, the authors said.

?People associate mental disorder with violence. We found that crime and mental disorder are linked, but not in the way people think. Persons with severe mental disorders are terribly vulnerable to victimization,”Teplin and co-investigators said.

?Since deinstitutionalization in the mid-1960s, people with severe mental illness have had no choice but to live in the community. But we have denied them basic needs, such as safe housing, supportive services and adequate mental health treatment,”Teplin said.

Teplin and colleagues propose that mental health treatment include systematic screening and monitoring persons for victimization, skill-based prevention programs to help these individuals learn to minimize risks and interventions to reduce revictimization.

In terms of policy for dealing with these issues, the researchers propose building collaborative relationships between the mental health and criminal justice systems and advocacy.

?People don't think of crime victimization as a health disparity. But crime victimization disproportionately affects persons with severe mental disorder, especially racial and ethnic minorities. Moreover, many persons with severe mental illness are poor and homeless, adding to their risk,”according to the autors of this study.

Aspects of this American research and the recommendations arising from it may be a valuable contribution to debate about these and similar issues in other places, including the United Kingdom.

Teplin's co-researchers were Gary M. McClelland, research assistant professor; Karen M. Abram, assistant professor; and Dana A. Weiner, research assistant professor, department of psychiatry and behavioral sciences at Feinberg.

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