Predictor of violence among mentally ill: Lack of Treatment or failure to accept treatment
There are three primary predictors of violence among people with mental illness, including:
- History of past violence, whether or not a person has a serious brain disorder;
- Drug and alcohol abuse, whether or not a person has a serious brain disorder; and
- Failure to take medication.
Other indicators of potential violence in mentally ill include:
- Antisocial personality disorder;
- Neurological impairment;
- Type of delusions (i.e., paranoid delusions – feeling that others are out to harm the individual and a feeling that their mind is dominated by forces beyond their control or that thoughts are being put in their head); and
- Type of hallucinations (i.e., command hallucinations).
- An estimated 4 million Americans today suffer from the severest forms of serious brain disorders, schizophrenia and bipolar disorder. Various studies estimate that approximately 50 percent of these individuals, or 2 million people, are not receiving treatment on any given day.
- Recent studies have shown that about half of individuals with schizophrenia or bipolar disorder have acutely impaired self-awareness of their illness; there is no self-recognition of the illness because their brain disease has affected the frontal-lobe circuits necessary for complete self-awareness. These individuals do not realize that the hallucinations, delusions, paranoia and withdrawal they are experiencing are in fact symptoms of their illness. Those people with untreated serious brain disorders who lack insight might really believe that the CIA implanted electrodes in their brains or that their neighbors are shooting rays into their homes in an effort to control them (For more information, see the Briefing Paper on anosognosia.)
- Violent episodes by individuals with untreated schizophrenia and bipolar disorder have risen dramatically, now accounting for 1,000 homicides annually (out of a total of 16,000 murders) in the United States.
- According to a 1994 Department of Justice Statistics Special Report, “Murder in Families,” 4.3 percent of homicides committed in 1988 were by people with a history of untreated mental illness (based on 20,860 murders nationwide). The report also found:
- of spouses killed by spouse – 12.3 percent of defendants had a history of untreated mental illness;
- of children killed by parent – 15.8 percent of defendants had a history of untreated mental illness;
- of parents killed by children – 25.1 percent of defendants had a history of untreated mental illness; and
- of siblings killed by sibling – 17.3 percent of defendants had history of untreated mental illness.
- Homicide is but one tragic result of untreated brain disorders. Other consequences are homelessness, victimization, imprisonment, suicide, acts of aggression upon family members, and increased economic costs to society.
- Studies have confirmed that the association between violence and untreated brain disorders continues to be widespread:
- A 1998 MacArthur Foundation study found that individuals with serious brain disorders committed twice as many acts of violence in the period immediately prior to their hospitalization, when they were not taking medication, compared with the post-hospitalization period when most of them were receiving assisted treatment. (The study showed a 50 percent reduction in rate of violence among those treated for their illness. Roughly 15.8 percent of individuals with a severe brain disease committed an act of violence prior to hospitalized treatment, compared with only 7.9 percent of these same individuals post-treatment.)
- In 1992, sociologist Henry Steadman studied individuals discharged from psychiatric hospitals. He found that 27 percent of released patients reported at least one violent act within four months of discharge.
- Another 1992 study, by Bruce Link of Columbia University School of Public Health, reported that ill individuals living in the community were three times as likely to use weapons or to “hurt someone badly” as the general population.
- A 1990 study of families with a seriously ill loved one reported that 11 percent of the ill individuals had physically assaulted another person in the previous year.
(Note: While failure to take medication is one of the top three predictors of violence, civil rights lawyers have continuously expanded the rights of those with a lack of insight into their illness to refuse to take medication. Past history of violence is another major predictor of violent behavior, yet in many states these same civil rights attorneys have restricted testimony regarding past episodes of violence in determining the present need for hospitalization and assisted treatment.)