Understanding causal paths between mental illness and violence

Abstract

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.

The Relationship Between Substance Abuse Treatment and Crime Relapse Among Individuals with Suspected Mental Disorder, Substance Abuse, and Antisocial Behavior: Findings from the MSAC Study

“…Previous research strongly suggests a relationship between severe mental illness and criminality (Arboleda-Floréz & Crisanti, 1998;Hodgins, Mednick, Brennan, Schulsinger & Engberg, 1996;Hodgins, Alderton, Cree, Aboud, & Mak, 2007). Findings from the Epidemiological Catchment Area study (ECA) concluded that comorbidity of addictive problems and severe mental disorder was approximately 90% in Downloaded by [University of Kent] at 08:56 04 December 2014 the prison population (Swanson et al, 2000).…”

Predicting community violence from patients discharged from acute mental health units in England

“…It is difficult to prove a causal link between risk factors and violence [43], but the overall findings highlight that in acute mental health populations there is a need to focus on what the person has done, (past and recent history of violence) what the person is (angry, impulsive, aggressive) and what the person has (personality disorder, psychopathy) [20] and substance misuse should remain a focus in risk assessment in both males and females. Although efforts have been made to develop an evidence-based actuarial tool for clinicians based on the findings of MacVRAS [28] further validation studies are still required and the challenge remains for clinicians in acute mental health services to apply the findings from this study and others into practice.…”

Civil commitment due to mental illness and dangerousness: the union of law and psychiatry within a treatment‐control system

“…Among such possible problems are of course violent or threatening acts ± or the perception by others of a threat when it is more or less contained in the interpersonal situation and dynamics, as observed by ± and fears for the safety of the person who will become a candidate for the diagnostic process. This issue has not been raised in the dangerousness assessment literature, except recently by Arboleda-Florez et al (1998). These authors characterised the problem as`confounding by definition', which seriously mars any causal inferences that could be made based on empirical evidence showing a statistical association between mental illness and violence'.…”