The stigma associated with mental illness is a major concern for patients, families, and providers of health services. One reason for the stigmatization of the mentally ill is the public perception that they are violent and dangerous. Although, traditionally, mental health advocates have argued against this public belief, a recent body of research evidence suggests that patients who suffer from serious mental conditions are more prone to violent behaviour than persons who are not mentally ill. It is a point of contention, however, whether the relationship between mental illness and violence is only one of association, or one of causality; that mental illness causes violence. A proven causal association between mental illness and violence will have major consequences for the mentally ill and major implications for caregivers, communities, and legislators. This paper outlines the key methodological barriers precluding casual inferences at this time. The authors suggest that a casual inference about mental illness and violence may yet be hasty. Because a premature statement advocating a causal relationship between mental illness and violence could increase stigma and have devastating effects on the mentally ill the authors urge researchers to consider the damage that may be produced as a result of poorly substantiated causal inferences.

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.

Persistently mentally ill residents of psychiatric facilities express clear preferences about key aspects of community-based care when they are asked, and these preferences often reflect different views from those expressed by either family members or clinical care providers.

As part of an ongoing epidemiological investigation into the prevalence of mental illness among remanded offenders, data were collected on the lifetime prevalence of suicide behaviours. Out of 1151 inmates interviewed, 20.7% of males and 34.0% of females reported a prior suicide attempt. Age and gender standardized comparisons to the general population revealed remandees to be 11.24 times more likely to have a history of suicidality. Also, a greater proportion of suicide attempters met the diagnostic criteria for a mental disorder (75.8I%), compared to non-attempters (56.1 %). The most frequently occurring diagnosis in both groups was psychoactive substance abuse, but suicide attempters were more likely to meet the criteria for a mood or personality disorder. Persons with multiple previous attempts had a higher prevalence of mental illness compared with single attempters. Lifetime history of a suicide attempt was found to predict a current mental illness with 70.6% accuracy. Therefore, when it is impossible to conduct detailed diagnostic assessments, past history of suicide attempts could be effectively used as a marker for mental illness for purposes of special handling and placement within a remand setting. Determining whether there is a history of suicide attempts should be an obligatory item on a cursory medical review of all incoming offenders to support judgements concerning special mental health needs.