Mental Nurse

Mental health and violence has long been given an erroneously represented causal link. Indeed, it has long been the promulgation of sensationalist reporting of ‘mental patient does harm’ that has sustained this misconception. For some time there has been a post on Mr Man’s Wife’s blog on just this topic.

I decided to bring some of the thinking over to here and add to previous discussions on the topic.

In understanding the link between violence and mental health, many studies have attempted to prove where positive correlation lies and where it does not <see google for a shit load>. At this juncture, most research would point towards the following:

Mental illness does increase risk.

Risk is increased significantly more when co-morbid substance misuse is present

Risk is increased 9-fold when high psychopathy scores are present (PCL-r)

A summary understanding of this concept can be found <here>

Taylor and Gunn (1999) provided a comprehensive review of homicide and mental illness which found that there was no rise in the absolute numbers of people with mental illness committing homicide. They even showed that in there was in fact a decline in this assumed casual association of the preceeding 40 years.

So how should this change the current societal attitude to violence and mental disorder?

Hopefully it will reduce the automatic attachment of violence where mental disorder also appears and perhaps encourage our journalists to remember that mental illness alone is only considered responsible in a few cases. I won’t argue that mental illness does not present any risk, but such fundamental awareness may open the way for a greater understanding of how violence occurs in mental illness and how it is much more likely to be caused by other factors.

However, it is those times like this (and thankyou Joe for the link) where, without knowing the existence or not of any co-morbid substance misuse, mental illness is considered to be the primary factor and thus a mental health defence, (which incidentally always leads to a more severe restriction and lengthier detention than the non-mental health defence counterpart - another debate), is afforded.

But let’s say, where psychopathy is low or absent; where there is no co-morbid substance misuse and the individual ‘merely’ has a major mental illness; how so does violence occur in this scenario?

A study by Simpson et al (2003) showed simlar results to that of Taylor and Gunn (1994).

“As with prior work, the mental illness most associated with violence is psychotic illness. It is the presence of delusions and hallucinations that is associated most commonly with violence, and less commonly affective disorders and organic disorders

(Link et al, 1998; Swanson et al, 1996; Taylor and Gunn, 1984).”

These are what are more often referred to as the positive symptoms of schizophrenia

As there are reportedly as many as 1 in 100 diagnosed with schizophrenia, why aren’t there then 1 in 100 people going around attacking people?

Well this might be that the diagnoses is made on negative symptoms alone, so we could exclude those (though another argument may include these due to deficiencies in social functional coping that may lead to loss of certain protective factors). However, as a Harvard article suggests 25% of schizophrenic diagnoses are made on negative symptoms only, this still leaves 3 in every 400.

In a population of over 60,000,000 (UK) - this suggests about 450,000 people in the UK are experiencing positive symptoms of schizophrenia.

So, if positive symptoms cause violence, why aren’t there as many violent incidents to reflect this linearly?

References

Link, B. G., Stueve, A., & Phelan, J. (1998). Psychotic symptoms and violent behaviors:Probing the components of “threat/control-override” symptoms. SocialPsychiatry & Psychiatric Epidemiology, 33(Suppl 1), S55-S60.

Swanson, J. W., Borum, R., Swartz, M. S., & Monahan, J. (1996). Psychotic symptoms and disorders and the risk of violent behaviour in the community. Criminal Behaviour & Mental Health, 6(4), 309-329.

Taylor, P. J., & Gunn, J. (1984). Violence and psychosis. I. Risk of violence among psychotic men. British Medical Journal Clinical Research Ed.. 288(6435), 1945-1949.

Taylor, P. J., & Gunn, J. (1999). Homicides by people with mental illness: Myth and reality. British Journal of Psychiatry, 174, 9-14.

Editorial Note: “doing an ‘E’ ” refers to the way I’ve copied E’s modality of splitting large posts into two. Not taking Ekkys. Part Deux to follow