Family violence by persons with serious mental illness Travis Labrum, PhD, LCSW Labrum, T., & Solomon, P. L. (2016). Factors associated with family violence by persons with psychiatric disorders. Psychiatry Research, 244, 171-178

Introduction Most persons with SMI do not commit violence 2 to 8 times more likely to commit violence Only 14% of violence towards strangers At least 50% of all victims family members Family members more likely to incur repeated violence and severe injuries

Prevalence “among family members with high levels of contact with their relative with psychiatric disorders, the best available estimate is that 20% to 35% have been the victim of violence by their relative with psychiatric disorders in the past 6 to 12 months and at least 40% have been the victim of such violence since their relative’s onset of illness” Labrum, T., & Solomon, P. L. (2015). Rates of victimization of violence committed by relatives with psychiatric disorders. Journal of Interpersonal Violence. Advance online publication. doi:10.1177/0886260515596335

Consequences of family violence Injuries and death Psychological distress & trauma symptoms Damaged and disconnected relationships Incarceration of persons with SMI Stigma of mental illness

Factors related to violence The Social-Ecological Model https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html

Individual: Perpetrator Factors Younger age Male Gender Lower income Drug and alcohol use History of crime/arrest Frequency of hospitalization Paranoia Medication and treatment non-adherence Impaired social and other cognition

Individual: Victim Factors Younger age Lower income Having a mental illness

Interaction Factors Co-residence Frequency of contact Financial assistance Money management Caregiving Limit-setting Criticism, hostility, not feeling “listened to” Re IPV, mutual physical & psychological abuse

Community Factors Living in a community with Greater poverty and social disadvantage More community violence Less access to mental health treatment

Societal Factors* Favorable attitudes towards violence Policies that perpetuate inequality Stigma towards people with mental illness and their families

Practice Implications Risk of violence and conflict should be assessed CBT and cognitive remediation may be effective Decreasing risk of violence with clients Importance of SA & MH treatment. Increase palatability of treatment. Refer to and advocate for greater services (housing assistance, intensive case management, richer welfare benefits)

Implications (cont.) Refer to NAMI’s “Family to Family” Involve family members in tx Most persons want involvement With both parties, discuss communication patterns, perceived hostility, incendiary communication, & not feeling “listened to”.

Implications (cont.) Assist relatives in decreasing or modifying the use of limit-setting practices Assess whether persons with SMI perceive limits as ill- intended or coercive Educate families on financial literacy & how representative payeeship operates Facilitate collaboration in financial decision-making

The end labrum@uwyo.edu