Violence Among the Severely Mentally Ill

July 6 juillet 8:30 – 10:00
Room NCDH–200

Chair: Peter G.J. Greeven , Ministry of Justice, The Netherlands

Studying violent incidents: Methodological issues

Charles Lidz  

University of Massachusetts

Research suggests that the amount of low level violence is very high among people with mental illness, at least in the US. Whether it is greater among people who are similarly situated but not mentally ill is still uncertain, but it is clear that this is a serious problem, both for people with mental illness living in the community and for those with whom  they live. If we are to find ways of reducing this sort of violence, we must learn how it comes about. The paper describes a study of violent incidents based on intensive interviews with both parties of the incident. Gathering reliable data on the events involved, and the integration of the two different accounts present substantial methodological problems which, however, are manageable if adequate resources are committed to the task. The paper describes some solutions to these problems and discusses future work that needs to be done.

The social-environmental context of violent behaviour in persons with severe mental illness

Jeffrey Swanson, Marvin Swartz 

Duke University

Recent studies suggest that the causal determinants of violent behavior in persons with mental disorder are varied and complex. The large majority of persons with severe mental illness (SMI) do not commit violent acts. Psychopathology plays some role in explaining violent behavior when it does occur in this population, but other variables are perhaps equally important. Using multivariable analysis of a large, pooled sample of individuals with SMI (N=802), this study examined a range of potential risk factors for violence. Three salient variables–history of violent victimization, exposure to violence in the surrounding environment and co-occurring substance abuse–were found to exert a cumulative effect on violence risk. Subjects with none of these three risk factors had less that a 1% predicted probability of violent behavior in a year–i.e. less than the rate that other studies have reported for the general population without mental illness. However, subjects with all three risk factors combined had a 30% predicted probability of acting violently. These analyses support the view that violent actions by adults with SMI may result from multiple variables with compounded effects over the lifespan, with an important role attributable to developmental experience and the social environment, as well as clinical status. Effective community-based interventions to manage risk in such individuals must be comprehensive and broadly focused, addressing multiple problems including underlying psychopathology, addiction, trauma sequelae, and need for community support.

Dangerous and incompetent:  Employers’ perceptions of mental illness

Teresa L. Scheid  

University of North Carolina at Charlotte

This research examined the effect of the Americans with Disabilities Act on the employment of individuals with mental disabilities. We surveyed a random sample of 117 employers in a large metropolitan community in the Southeast US and asked questions about their employment practices as well as their attitudes towards those with various types of mental illnesses or disabilities. Previous research has found that employers held stigmatized and ignorant attitudes toward those with mental illnesses, and were reluctant to hire these individuals. Employers were also found to hold false assumptions about job-related abilities and the costs of accommodations. Our data confirm these findings, and also demonstrate that employers continue to hold stigmatizing attitudes, and are particularly concerned with the potential dangerousness of those with mental illnesses. Employers also tended to associate mental illness with incompetence. Such attitudes reflect public misconceptions and common stereotypes and consequently limit the employment opportunities of millions of individuals.

Filicide

 George B. Palermo

Medical College of Wisconsin

Family violence has been present since the beginnings of humankind. This presentation offers observations regarding some of its major manifestations - neonaticide, infanticide and filicide from an historical perspective. Observations are drawn from mythological tales and early cultures, the Middle Ages, the Renaissance, and the present.  The dyadic relationship between parent-child, and especially mother-child attachment and bonding are touched upon. Nature/nurture and biological/environmental assumptions are discussed. A brief typology of murdering mothers or fathers seen in forensic psychiatric practice, supported by six case studies (1 neonaticide, 2 infanticides, and 3 filicides) is presented. Recent literature is noted and a psychodynamic formulation is proposed.


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