Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Outcomes

Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Psychiatric Services (Impact Factor: 2.41). 03/2008; 59(2):153-64. DOI: 10.1176/
Source: PubMed

ABSTRACT This review examined U.S. empirical studies published since 1990 of the perpetration of violence and of violent victimization among persons with severe mental illness and their relative importance as public health concerns.
MEDLINE, PsycINFO, and Web of Science were searched for published empirical investigations of recent prevalence or incidence of perpetration or victimization among persons with severe mental illness. Studies of special populations were included if separate rates were reported for persons with and without severe mental illness.
The search yielded 31 studies of violence perpetration and ten studies of violent victimization. Few examined perpetration and victimization in the same sample. Prevalence rates varied by sample type and time frame (recall period). Half of the studies of perpetration examined inpatients; of these, about half sampled only committed inpatients, whose rates of perpetration (17%-50%) were higher than those of other samples. Among outpatients, 2% to 13% had perpetrated violence in the past six months to three years, compared with 20% to 34% who had been violently victimized. Studies combining outpatients and inpatients reported that 12% to 22% had perpetrated violence in the past six to 18 months, compared with 35% who had been a victim in the past year.
Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population. Victimization is a greater public health concern than perpetration. Ironically, the discipline's focus on perpetration among inpatients may contribute to negative stereotypes.

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    • "As a consequence, perpetrators and victims are hosted in the same wards and often are one and the same individual (see e.g. Choe et al., 2008 for an overview of the risks of victimization in institutions). All in all, treatment staff needs to handle a variety of problem expressions, which highlights the importance of staff member's formal competence and practical skills (Ahonen and Degner, 2012; Andreassen, 2003; Roush, 1997; Sinclair and Gibbs, 1998), as treatment organizations become more and more result oriented. "
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    International Journal of Prisoner Health 11/2014; 10(4):239-251. DOI:10.1108/IJPH-04-2013-0018
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    • "The perception that people with severe mental illness (SMI) are dangerous is one of the key drivers of stigma against this group (Link et al. 1999). However, there is increasing evidence that violence against SMI patients is an important, under-researched public health problem (Choe et al. 2008). "
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    ABSTRACT: Background: Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population. Method: Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾ 1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey. Results: Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7-4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0-2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4-5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001). Conclusions: Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
    Psychological Medicine 09/2014; 45(04):1-12. DOI:10.1017/S0033291714001962 · 5.94 Impact Factor
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    • "While perceptions of people with mental illness as dangerous or potentially violent are frequently exaggerated (Markowitz, 2011) a significant subgroup presents an increased risk of violence (Choe, Teplin, & Abram, 2008). This subgroup includes people who are experiencing acute psychosis and who have consumed alcohol or other substances (Van Dorn, Volavka, & Johnson, 2012). "
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    ABSTRACT: The proliferation of Tasers among police forces internationally has been accompanied by concerns about injuries and health effects, and about the use of Tasers on vulnerable populations such as people with mental illness. Tasers have generated a flood of research studies, although there remain unanswered questions about some of the key issues. This paper outlines the introduction of Tasers to policing and their subsequent widespread adoption. The paper considers the role of police in mental health emergencies with a particular focus on use of Tasers. Some factors contribute to the special vulnerability of people with mental illness to the effects of Tasers. The paper also reviews research into use of Tasers and raises issues about conflict of interest in Taser research. We conclude that Tasers look set to play a significant role in policing in the future. We make suggestions for a future research programme, and suggest guidelines for publication of papers in which there may be a conflict of interest.
    International Journal of Law and Psychiatry 07/2014; 37(4). DOI:10.1016/j.ijlp.2014.02.014 · 1.19 Impact Factor
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