University Park, Pa. -- Poverty and its accompanying stresses and dangers are important factors influencing people with psychiatric disorders toward violence, researchers say.
"Of the 293 psychiatric patients we studied, 30 percent lived in neighborhoods blighted by severe poverty. Of these, 23 percent subsequently showed some kind of violent behavior toward others after their discharge from psychiatric treatment," says Dr. Eric Silver, research associate with Penn State's Center for Research on Crime and Justice and the University's Population Research Institute.
Silver; Dr. Edward P. Mulvey, Law and Psychiatry Program, Western Psychiatric Institute and Clinic, University of Pittsburgh; and Dr. John Monahan, School of Law, University of Virginia, published their study in "Assessing Violence Risk Among Discharged Psychiatric Patients: Toward an Ecological Approach," in a recent issue of Law And Human Behavior, official journal of the American Psychology-Law Society.
The study, co-funded by the John D. and Catherine T. MacArthur Foundation and by the National Science Foundation's National Consortium on Violence Research, surveyed patients in the community between 1992 and 1995 after being treated and discharged from an acute psychiatric inpatient facility in Pittsburgh, the Western Psychiatric Institute and Clinic.
"It would appear that people living in neighborhoods with concentrated poverty increasingly tolerate behaviors considered unacceptable or even criminal by the larger society. Thus, patients discharged to such areas may be influenced by behavior norms that are quite different from those influencing patients discharged to areas with less poverty," notes Silver.
Often, individuals with mental illnesses find themselves in stressful situations that result in violence as others may try to persuade them to stop their unusual behavior or to comply with psychiatric treatment, according to Silver.
"Those situations may result in fighting, especially in neighborhoods where physical aggression is commonly used to resolve disputes. Furthermore, the vulnerability of persons with major mental disorders may make them attractive targets for bullying, especially in these neighborhoods," he says.
"We interviewed patients twice during the five months following their discharge from the hospital," says Silver. "To monitor their progress, we also interviewed family members as well as friends, professionals, significant others and co-workers."
Violent behaviors consisted of acts of battery, such as kicking, biting, choking or hitting with a fist or object, that resulted in injury to another person, sexual assaults, threats made with a weapon in hand, or use of a weapon.
Overall, the study found that 41 patients (14 percent) committed a violent act during the five-month follow-up period, 10 percent were rearrested and 25 percent were rehospitalized.
"Our findings make clear that, when assessing the potential for violence among discharged psychiatric patients, policy makers and clinicians must consider the patients' current living environment," Silver adds.
EDITORS: Dr. Silver is at (814) 865-8867 and exs44@psu.edu by email.
Journal
Law and Human Behavior