What are the links between violence and mental illness? Update from Harvard Review of Psychiatry

January 13, 2021 - When there is news of a violent attack, we sometimes hear that it could be related to mental illness - which may make us ask whether the violence could have been predicted or prevented. Current research and perspectives on associations between violence and mental illness are presented in the special January/February issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"[T]he articles in this Special Issue serve to summarize important facets of the complex connection between mental illness and violent behavior, and to illuminate the potential for mental health practitioners and researchers to play a more productive role in preventing violence," according to an introduction by Guest Editor Jeffrey Swanson, PhD, Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine.

Expert insights on treatment and prevention of violence related to mental illness Violence and serious mental illness are two "top tier" public health problems in the United States. However, it's difficult to demonstrate and understand the connections between them, if any. Research suggests that only a small fraction of violent acts occurring in the community - three to five percent - are attributable to mental illness. "The large majority of the perpetrators of violent crimes do not have a diagnosable mental illness, and conversely, most people with psychiatric disorders are never violent," Dr. Swanson writes.

Representing a broad range of intellectual and clinical perspectives, the Special Issue articles "reflect both the multifaceted nature of the problem and the importance of interdisciplinary research to inform effective interventions and policies to try to solve it." Topics include:

Mental health treatments to prevent violence. Two articles review current research and practice on medications and behavioral therapies to reduce hostility and aggression, focusing on schizophrenia and autism spectrum disorders. While there's evidence that some treatments do work to reduce violent behaviors, it remains unclear how they work - especially in these two fundamentally different disorders.

Violence against family. Caregivers and other family members of people with serious mental illness are often victims of violence; evidence suggests that 1 out of 5 family members are affected. In addition to usual risk factors such as substance abuse and not taking prescribed medications, family dynamics may contribute to these events.

Violence risk assessment. Assessing the risk of violence in individual patients poses difficult challenges for mental health professionals. An expert column addresses the real-world situations in which these assessments are done, where clinicians "must balance ethical and clinical concerns at the intersection of safety with coercion and fairness."

Mass shooting events. A "Perspectives" article offers insights into the role of mental illness in mass casualty shootings. The authors propose a strategy for studying the complex causes of these tragic events, with a broader collaborative role for psychiatry in trying to prevent them. Researchers should "deliberately reject the stigmatizing assumption that psychopathology is the main driver of a mass casualty shooting."

Gun violence prevention. Dr. Swanson is lead author of an article making the case for state laws allowing psychiatrists or other professionals to petition for court orders to remove firearms from patients who pose an "imminent risk" of harm to themselves or others. A growing number of states have enacted extreme risk protection orders - sometimes called "red flag" laws - enabling law enforcement to temporarily remove guns from people with behaviors indicating imminent risk of violence. An accompanying "Disruptive Innovations" essay discusses the potential advantages and challenges of this role for mental health professionals.

Dr. Swanson voices the hope that the Special Issue articles will provide a useful guide to future research toward meeting two critical, complementary goals: "to meaningfully reduce the toll of violent injury and mortality in the population, and to safely and respectfully integrate people with mental illnesses into community life, with the acceptance and support that will allow them to thrive."

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Click here to read "Introduction: Violence and Mental Illness." DOI: 10.1097/HRP.0000000000000281

The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

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