Violence

Preventable Tragedies: Violence

People with serious mental illness (SMI) are more likely than the general population to cause harm to themselves and others, with elevated rates of both self-harm and interpersonal violence. Discriminatory stereotypes perpetuated by media and high-profile commentary on acts of mass violence have spread the falsehood that most acts of mass violence are driven by severe mental illness. While there is evidence to suggest that psychosis is a risk factor for interpersonal violence, the people most likely to be impacted by interpersonal violence caused by psychotic symptoms are family members, not the general public.

The role of treatment access in reducing interpersonal violence

When understanding and interpreting violence from people with SMI, it is important to note the role of treatment access. When pursuing treatment for an acutely symptomatic loved one who is unable to seek and maintain care on their own, some family members have reported being told by care providers that their loved one would only meet criteria for an emergency psychiatric evaluation after harm had occurred, and that they must wait until their loved one deteriorates to the point of crisis and attempts to harm themselves or someone else for treatment intervention.

Overall, receiving treatment has been associated with a reduced risk of interpersonal violence. Antipsychotic medications like clozapine have demonstrated effectiveness at reducing the risk of violent behavior among people with SMI. There is also some evidence for the effectiveness of psychosocial and cognitive treatments like cognitive behavioral therapy for psychosis (CBTp) and cognitive remediation in reducing violent behavior. People with SMI engage in violent behavior for a range of reasons, including attempting to protect themselves, regulate intense emotions, and escape from psychotic experiences. Interventions that help people with SMI to process their experiences, emotions, and responses to their symptoms may be an important tool for reducing risk of violence accordingly.

While treatment has been shown to reduce the risk of interpersonal violence, there are also several factors that increase this risk among people with severe mental illness. These are largely the same as risk factors for interpersonal violence among the general population, including a history of criminal legal involvement and substance abuse.

Very few people with SMI commit acts of violence, so why discuss it?

It is incorrect to assume and perpetuate the stereotype that all people with SMI are dangerous or at risk of violence. However, it is also important to acknowledge the association between psychotic symptoms and violent behavior, especially in criminal proceedings when a person is charged with a violent crime that they may not be criminally liable for due to the severity of their symptoms at the time the alleged criminal offense.

Some mental health advocates and family members may be concerned that discussing the relationship between psychosis and violence can be stigmatizing or perpetuate negative stereotypes about people with SMI. In reality, a failure to acknowledge the relationship between psychotic symptoms and violence directly contributes to the criminalization of SMI. It is important for the public, prosecutors, and judges to understand that the compassionate and appropriate response to people with SMI who commit acts of interpersonal violence because of their symptoms is to deflect or divert them from the criminal system and provide evidence-based treatment to decrease the risk of future violence. Recognizing the relationship between violence and psychotic symptoms is necessary to that end.

If you or a loved one is concerned about risk of violent behavior, our Schizophrenia and Psychosis Resource Center has a number of resources that you may find helpful, including resources on how to make your home safer and how to plan for emergencies. You can also send our team an email at help@tac.org, and we will respond within one to three business days. If risk of harm is imminent, please contact 988.