PIIMIC Glossary

V

Violence - There are many variables in violent behaviour that make it difficult to formulate an accurate assessment of risk in individual situations.Key factors that are known to affect the risk of violent or dangerous behaviour in a mentally ill person, include:

• Past history of violence. This is the strongest predictor across the board (whether mental illness is present or not).
• Specific type and state of the mental disorder, its symptoms and behaviour patterns, whether it is being treated, and how diligent and comprehensive the treatment is. Untreated illness or abruptly-halted treatment is likely to increase the risk.
• Complications like concurrent substance abuse. Street drugs or alcohol abuse increase the risk of violence across the board.
  d)Despair or desperation from extra stresses like alienation or homelessness, or being bullied; and from fearfulness, such as feeling that personal control is being threatened or over-ridden, or feeling one’s mind is being dominated by outside forces. Such feelings may arise from reality and/or from delusions. 

Family members, not the general public, are the most likely targets of violence from people previously hospitalized for mental illness and with a known risk pattern for committing violent acts. For police purposes, a threat of violence involving family or any other specific target is not only endangering under legal intervention criteria but may pose a common-law duty to warn any intended or potential victims. “Where such a duty is found to exist, it over-rides issues of privacy and confidentiality. Such a duty is not yet clear-cut in Canada but Canadian courts have allowed physicians to breach their duty of privacy and confidentiality,” explains mental health legal expert Gerrit Clements of Victoria BC. See Legal Issues sub-topic: Threats and duty to warn.

Mental health organizations are concerned about stigma issues in mental illness, including the violence stigma, because undue negative publicity hinders efforts to build up treatment resources and community support. Some studies show people with mental illness are no more violent than people in general. (This is especially true for treated illness.) Other studies show an elevated risk, but find it is no greater than the difference between violence in men and in women, or between teenagers and adults. “If you want to protect yourself from violence, you would do just as well to avoid men and teenagers as you would to avoid people with mental illness,” says Dr. Bruce Link, psychiatric epidemiologist at the Columbia University School of Public Health in New York. He and other experts are concerned about sensationalized media reports on high profile crimes, where any mental illness jumps to the top of the story and reinforces the false notion that mental illness equals violence. Dr. Link points out that mental illness is a very small contributor to overall levels of violence.