Mental Illnessand Violence – The Interaction of Clinical and Social Factors in Forensic Psychiatric Practice

Abstract

The relationship between mental disorder and violence still remainsextremelyimportantfor both professionals and the general public. Do people with mental disorders have an increased risk of violence? Which additional factors influence aggressive behavior? Is it possible to reduce the risk of violent behavior? The study of these issues is crucial both in terms of public health and for the proper planning and development of mental health services. This paper reviews the international data devoted to the study of association between violence and mental illness and factors that increase the risk of violence in those with mental illness.Most researchers and professionals agree that a combination of various biological and psycho-social factors play a role in violence and aggression, although there are differing opinions regarding the importance of individual factors. According to the authors, research on mental illness and dangerousness has been traditionally typified by methodological problems that might explain the great variety of results obtained in different studies.However, general conclusions including the following: severe mental disorder alone is not a sufficient predictor of future violence; important role plays such factors as historical(past violence, physical abuse, juvenile detention, parental arrest), clinical (substance use, perceived threats), dispositional (age, sex, income) and contextual (recent unemployment, divorce, victimization). According to the authors, people with severe mental disorders are still more likely to engage in violent acts, largely because they are more likely to be affected by other accompanying factors related to violence.There is research evidence that substance use dramatically increases the risk of a violent incident. In patients with schizophrenia, a higher risk of violent behavior was associated with concurrentsubstance use. Similarly, it has been found that in bipolar disorder, the risk of violent crime is mainly related to the coexistence of substancemisuse.Studies investigating the prevalence of violence behavior in psychiatric patients show that the data are quite variable depending on the type of treatment setting. The lowest prevalence was observed in outpatient facilities and the highest in acute ward and in invol untarily settings. Psychotic symptoms (hallucinations, delusions, persecutory thoughts) increase the risk of both serious and minor crimes, while negative symptoms (social avoidance, anhedonia, lack of motivation and energy) reduce the risk of serious but not minor crimes. Untreated psychotic symptoms are a significant risk factor for violent behavior, especially those that frighten the patient and cause loss of control. Studies also show that people with severe mental disorders constitute a high-risk vulnerable group, because they can easily become victims of violence. Symptoms associated with severe mental disorders, such as impaired reality testing, disorganized thought process, impulsivity and poor planning and problem solving ability, can prevent a person from recognizing risks and protecting oneself. Based on the literature data, it can be said that the dynamic interaction of social and contextual factors with clinical variables plays an important role as a determinants of violence. However, studies of the causal factors of violence have focused largely on patient diagnosis or clinical variables, with little attention to the potentially important other accompanying factors. When mental health services fail to meet the needs of persons with mental disorder, there is a risk that these people will commit a crime or fall victims of violence. Objective scientific studies on violence and mental illness will help to better understand the interests of both patients and society and develop appropriate strategies.