¶ … Social-Environmental Context of Violent Behavior in Persons
Treated for Severe Mental Illness
Concept Introduction
Society as a whole understands that two major demographic predictors of violent behavior are being male and being young. Two major clinical predictors of violent behavior are a past experiential history of violence (e.g., in the home, the community, personal delivery or receipt of violent acts or behaviors) and substance abuse (i.e., alcohol and/or drugs). Recently, it has been established that a third factor may well partner with these clinical predictors to violent behavior - being 'severely' mentally ill and refusing or refraining from taking disease management medications.
Premise
Severely mentally ill people who take their disease management medications are not more dangerous than the general population. The MacArthur Foundation Study on violence and mental illness found that psychiatric patients without substance abuse influences were no more likely to demonstrate violent behavior than any other individual in the same environment.
Premise 2
Severely mentally ill people who do not take their disease management medications are more dangerous than the general population. Several studies conducted during the 1970's - admittedly not well controlled - seem to demonstrate that those with 'severe mental illness' who were following a routine of non-compliance had an arrest rate 10 times higher than the general population.
Later studies continued to support this premise, citing " much higher rates of violent behavior among individuals with severe mental illness living in the community compared to other community residents." Individuals with schizophrenia were 21 times more likely to have used a weapon in a fight, develop an inverse correlation between their propensity toward violence and blood levels of antipsychotic medications, and be "driven" to offend by their delusions.
Article Content
In a four state study of 802 adults with severe mental illnesses (largely schizophrenic or schizoaffective disorders at 64%), this research team reports that 13.6% had been violent within the preceding 12 months. The team further defined "violent" as "any physical fighting or assaultive actions causing bodily injury to another person, any use of lethal weapon to harm or threaten someone, or any sexual assault during that period."
The report further states that those who had been violent were more likely to have been homeless, to be substance abusers, and to be already living in a violent environment. Those who had been violent were also 1.7 times more likely to have been noncompliant with antipsychotic medications.
As other such studies seem to support, the women with severe psychiatric disorders were almost as likely to have been violent (measured at 11%) as were the men (measured at 15%).
Because the data on violent behavior were collected by self-reporting methods, the authors suggested "that our findings are probably conservative estimates of the true prevalence of violent behavior for persons with SMI."
They concluded "that risk of violence among persons with SMI is a significant problem" and "is substantially higher than estimates of the violence rate for the general population."
Article Strengths
An impressive array of mechanisms were used to conduct this research; Statistical Significance tests; the Exposure to Community Violence Scale, an instrument adapted from a questionnaire used in the NIMH Community Violence Project; the Sexual Abuse Exposure Questionnaire; cross-sectional surveys; Epidemiologic Catchment Area surveys; Diagnostic Interview Schedule's assessment of antisocial personality disorder; the Conflict Tactics Scale; Sexual Abuse Exposure Questionnaire; PTSD Checklist - Civilian version; and others.
Another inherent strength in this study was the forthright willingness of the researchers to admit to the inherent limitations and potential flaws in the research. This admission paved the way for more detailed, specific demographic and experiential studies, which have led sociologists, criminal forensic scientists, medical professionals, and judiciary groups to a better understanding of the correlation between individual variables and violent enactment of these variables.
Article Weaknesses
Several publicly admitted weaknesses exist within this study; following are the author's perceptions of problematic limitations.
The ethnic sampling was skewed toward two racial groups: White/Anglo-Saxon and Black/African-American. With Hispanic ethnic groups a large and ever-growing sub-culture in the United States and the inherent cultural mores and values on violence in family defense, this group should have been a third ethnic sampling block.
The demographic sampling was limited to eastern states only. Various states - with their ethnic groupings, cultural alignments, and social mores - would add a more balanced sampling group that merely four from eastern states.
At least one of the sampling instruments - the Exposure to Community Violence Scale - produced a measurement designed...
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