Stigma and Mental Illness: Facts about Violence

When another episode of senseless violence occurs, such as a school shooting, mental health advocates hold their collective breaths as they wait to find out more about the perpetrator of such tragedy. If a mental health diagnosis is found, it fuels renewed public debate about violence and mental illness.

While discussion on finding better predictors of sudden, violent behavior can be valuable, what often gets lost in the noise of accusation and outrage is that mental illness is NOT closely associated with violence.  The exceptions, profiled on television screens and across the front pages of morning newspapers, stoke public fears and increase stigma about mental illness.

A look at a few facts about mental illness and violence, however, can help separate speculation from reality. Consider these facts:

1. Individuals with mental illness are not generally violent. When examining the incident of violent behavior, researchers have found that mental disorders are not a major cause. Only an estimated 3 – 5% of violent acts appear due to the presence of a serious mental illness. The MacArthur Violence Risk Assessment Study¹ found that having a severe mental illness alone was not a predictor of violence. Other factors, such as an individual’s past history of violence, social conditions, and substance abuse, were much greater predictors.
2. Treatment of mental illness further reduces the risk of violent behavior. Mentally ill individuals who undergo treatment are statistically no more likely to be violent than the general population. One study looked at psychiatric hospital patients one year after discharge and found that they had no higher rates of violent behavior than individuals without a psychiatric disorder.
3. The general public is not statistically at risk for aggression by the mentally ill. Isolated incidents may lead people to believe that they may be a likely victim of a deranged attacker, the MacArthur study also found that the infrequent acts of violence by those with mental illness were much more likely to occur with family members or close friends in the home. Such a finding is true of most violence in American society, regardless of one’s health status. Discharged psychiatric patients have actually been found to be less than half as likely as individuals without a mental illness to target complete strangers for aggression.
4. People who are mentally ill are more likely to be victims of violence. In one study, almost two thirds of hospitalized psychiatric patients reported that they had been physically victimized in the past year by someone they dated. Half of those who lived with family members reported being physically victimized. Another study compared the rate of criminal victimization of individuals with severe mental illness versus the general population. Over a four-month period, it was found that mentally ill individuals had a victimization rate of 8.2%, as compared to 3.1% in the general population. Untreated mental illness makes an individual more vulnerable to exploitation and violence by others. Much like some victims of child abuse, individuals may more likely to become part of a cycle of violence, sometimes reacting to violence with aggression. But they are also more than twice as likely to be a victim than a perpetrator.

Based upon the facts, it appears that individuals with serious mental illness need treatment and protection from violence more than suspicion and stigma. While horrible acts by individuals should not be defended, being armed with the facts can help the general public be less likely to give in to fear or to perpetuate myths that maintain stigma. Such stigma make it more difficult for individuals with mental illness to seek the treatment they so need.

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¹ Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York: Oxford University Press.