Are people with mental illnesses more violent than those without them?
Many state legislatures have recently acted on the idea that they are. While the increased funding for psychiatric treatment being enacting is long overdue and greatly appreciated, the linkage of violence, particularly gun violence, exclusively to mental illness is actually spurious and unfairly stigmatizes those with psychiatric diagnoses.
First of all, it is incorrect to ascribe mental illness only to “others.” While 5.5% of all adults suffer from serious mental illnesses,[1] a 46% lifetime incidence[2] and 17.6% annual prevalence[3],[4] for all mental disorders have been found in our global population. This means that half of us will meet criteria for any diagnosable mental disorder at least once during our lives, and about one in five of us will experience mental illness in any given year.
Secondly, about 4% of our population commits overt physical violence each year. This percentage is the same for those with and those without mental illness. A small percentage of people with mental illness are violent, the same amount as people without diagnosable mental illnesses, with substance abuse being a risk factor for both groups.[5] People with psychiatric diagnoses who are treated and stable, in fact, have lower rates of initiating violence than the population at large – their low risk of being violent is only slightly higher just before and after acute psychiatric hospital treatment.[5]
Higher rates of violence are linked not to medical diagnoses, but to lower socioeconomic status, unemployment, lower education level, and social instability.[6] In fact, the people most vulnerable to violence from everyone are the mentally ill.[7] Over 50% of people experiencing serious mental health problems are victims of physical violence without weapons, and half of women with serious psychiatric illnesses suffer rape,[8] which may lead to their much higher than expected rate of suicide attempts (53%).[9] In one study, severely mentally ill people were 14 times more likely to be victims of violent crimes than members of the general population.[10] They are also at high risk of violent threats (70%), sexual harassment (70.6% for women), and theft (54%).[8]
We all need to be protected, not scapegoated, especially when we experience mental health symptoms. Violence is endemic in our societies and has been for millennia.[11] Steven Pinker argues in The Better Angels of Our Nature that person to person violence has slowly declined to our current rate, but only because humans have been able to become more empathetic with each other.[12] We need to further reduce violent crimes against all members of society by caring about each other, looking out for those most vulnerable, following the real data about the problem, and instituting evidence-based solutions.
No, as a group, people with mental illnesses are not any more violent than those without them. We want to provide them the care that they need, but we will also have to address the real and broader causes of violence.
[1] Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Available at https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report. Published January 4, 2023. Accessed June 7, 2023.
[2] Kessler RC, Berglund P, Delmer O, et al: Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602, 2005
[3] McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Available at https://webarchive.nationalarchives.gov.uk/ukgwa/20180328140249/http://digital.nhs.uk/catalogue/PUB21748. Accessed June 7, 2023.
[4] Steel Z, Marnane C, Iranpour C, et al: The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 43(2):476-493, 2014
[5] Rueve ME, Welton RS: Violence and mental illness. Psychiatry (Edgmont) 5(5):34-48, 2008
[6] Stanton B, Baldwin RM, Rachuba L: A quarter century of violence in the United States: an epidemiologic assessment. Psych Clin N Am 20(2):269-282, 1997
[7] Thornicroft G: People with severe mental illness as the perpetrators and victims of violence: time for a new public health approach. The Lancet: Public Health5(2):E72-E73, February 2020
[8] Rossa-Roccor V, Schmid P and Steinert T: Victimization of People with Severe Mental Illness outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors from a Multicenter Study. Front Psychiatry 11:563860, 2020. doi: 10.3389/fpsyt.2020.563860
[9] Khalifeh H, Moran P, Borschmann R, et al: Domestic and sexual violence against patients with severe mental illness. Psychol Med 45(4):875-886, 2015
[10] Kamperman AM, Henrichs J, Bogaerts S, et al: Criminal victimisation in people with severe mental illness: a multi-site prevalence and incidence survey in the Netherlands. PloS One 9(3), 2014. doi: 10.1371/journal.pone.0091029
[11] Diamond J: The Third Chimpanzee: The Evolution and Future of the Human Animal. New York, Harper Perennial, 1992 (2006 reissue), pp. 276-310
[12] Pinker S: The Better Angels of Our Nature: Why Violence Has Declined. New York, Penguin Random House, 2012