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Violence & Mental Illness Facts & Myths Adapted from Yale Forensic Training Program (Norko, MD & Baranoski, PhD 1998)

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Presentation on theme: "Violence & Mental Illness Facts & Myths Adapted from Yale Forensic Training Program (Norko, MD & Baranoski, PhD 1998)"— Presentation transcript:

1 Violence & Mental Illness Facts & Myths Adapted from Yale Forensic Training Program (Norko, MD & Baranoski, PhD 1998)

2 Historical Association Between Dangerousness & Mental Illness Literature on violence and mental illness dates back to ancient Greek & Roman texts Religious doctrine reified link between aberrant behavior & evil (Dominican monks-hunting and disposing of witches, priests exorcising evil spirits) Advent of Lunatic Asylums-to segregate mentally ill (“protect public”)- not treat First 2 psychiatric “hospitals” in America were funded on premise of “danger” of mentally ill

3 Historical Association continued… Endorsement of “Animalism” as theory of madness- mentally ill are like animals 1843 first acquittal in murder case for the idea of mental defect (paranoid schizophrenia) Media blitz of sensational cases (attempted assassin of Reagan, Jessica Short, Uni-bomber) Movies & TV characters 73% mentally ill portrayed as violent, 23% homicidal -- vs – 40% normal portrayed as violent, 10% as homicidal

4 Enduring Public Perception There is a strong correlation between mental illness and violence Random targets Unpredictable behavior Societal discomfort with psychiatric illness Stigma of mental illness Loss of control Dependency and failure Diabolical & evil Irrational fear

5 Facts Statistics (Swanson, Holzer, Gangu et al, 1990) No disorder- 2% risk of violence in past year Major Mental Disorder -11-13% risk of violence in past year Alcohol Abuse -25% risk of violence in the past year Drug Abuse – 35% risk of violence in the past year Prevalence of alcohol abuse is approximately 13% in U.S. whereas prevalence of schizophrenia is 1% T herefore substance abuse creates a greater risk to society as the risk of assault is 20 times greater for individual abusing alcohol than and individual with schizophrenia.

6 Facts continued… Patients who begin substance abuse before the age of 15 are statistically more likely to become violent after onset of mental illness. Highest prediction of violence is when delusional thinking is co-occurring with substance abuse. Mental Illness alone is poor predictor of violence. (Grossman, Frobes, Ruthazer, 1997; Link 1994) Violence predicted by 3 specific active psychotic sxs Delusions that someone is doing the individual harm Delusions that the individual is being controlled by others Delusions of thought insertion Past psychosis is NOT related to risk

7 Dynamics of Violence Individual Factors Temporal Situational Factors Management

8 Individual Factors Psychiatric – Active sxs Command hallucinations Persecutory delusions Severe Depression (self-violence-suicide) Anti-social personality Frontal lobe injury (impulsivity) Previous exposure to violence Substance abuse Response to and compliance with treatment

9 Situational Factors Size, strength, and health of potential victim Availability of weapons Substances (what, frequency, effect) Presence of authority figure Living/ residential setting

10 Temporal Factors Special events Selected times of year (increased isolation, increased publicity about specific events) Availability of treatement Recency of high profile incidents

11 Management Factors Availability of services Adequacy of reporting behaviors/ observations Clear policy and procedures for identifying and mediating risk Family or other supportive service involvement


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