Discharged Mental Patients Without Substance Abuse Exhibit Same Rate Of Violence As Non-Mentally Ill Neighbors, Study Finds

What Did The Study Find?

The study found that patients discharged from psychiatric facilities who did not abuse alcohol and illegal drugs had a rate of violence no different than that of their neighbors in the community. Substance abuse raised the rate of violence both among discharged psychiatric patients and among non-patients. However, a higher portion of discharged patients than of others in their neighborhoods reported having symptoms of substance abuse, and -- at least when they first got out of the hospital -- substance abuse was more likely to lead to violence among discharged patients than among non-patients.

Why Are These Findings Important?

For decades, studies have tried to determine whether people discharged from psychiatric hospitals are more violent than their neighbors in the community. This research is often invoked in debates about whether standards for involuntary hospitalization are too tight or too loose, and whether halfway houses for discharged patients pose a threat to the those in the surrounding community. But no previous study used the same kind of powerful methodology employed in the MacArthur Violence Risk Assessment Study. Nearly 1,000 patients were studied in the community. They were interviewed every 10 weeks for the first year after their discharge from the hospital. In addition, one of their family members or friends was interviewed about the patient's behavior every ten weeks, and police and hospital records were examined.

What Is New About These Findings?

Older studies from the 1950s and 1960s tended to find that discharged patients were no more violent than others in the community. More recent studies from the 1970s and 1980s reported that discharged patients were more violent than their neighbors. This research directly addresses the contradictions in the scientific literature: discharged patients who do not abuse alcohol or other drugs are no more violent than their neighbors, while patients who do abuse alcohol or other drugs are significantly more violent immediately after discharge than others who live in their neighborhoods.

To Whom Is This Information Useful?

The significance of substance abuse in distinguishing the minority of discharged patients who will be violent to others from the majority who will not is important not only to persons with mental illness and their families, but to all residents of the neighborhoods in which discharged patients live.

Accurately understanding the relationships among mental disorder, substance abuse, and violence will be useful to both sides in ongoing policy debates about involuntary hospitalization and outpatient commitment and the placement of treatment facilities.

The research should be of particular interest to clinicians responsible for the care of persons with mental illness and for making decisions about hospital admission and discharge.

How Was The Study Done?

Nearly 1,000 male and female psychiatric patients between 18 and 40 years old were monitored for violence to others every 10 weeks during their first year after discharge. Short-term hospital units in Pittsburgh, Kansas City (Missouri), and Worcester (Massachusetts) participated in the research. Patient self-reports of violence were merged with reports from "collaterals" -- usually family members or friends -- with police and hospital records. A comparison group consisted of more than 500 people living in the same neighborhoods as the Pittsburgh patients who were interviewed once about violence in the past 10 weeks.

Who Is Sponsoring The Study?

The study was funded by the John D. and Catherine T. MacArthur Foundation in Chicago and by the National Institute of Mental Health.

What Are The Next Steps Planned In This Project?

The researchers are now in the process of using their data to develop a new statistical risk assessment instrument that can be used to help clinicians distinguish "higher violence risk" patients from "lower violence risk" patients much more accurately than has been possible in the past.

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