3.2 Mental health and violence

Mental health disorders can sometimes increase the risk of violence, but most people with mental illness aren't violent. Specific symptoms like psychosis or mania may raise concerns if untreated. Substance abuse and environmental stressors can worsen the situation.

Media often misrepresents the link between mental illness and violence, causing harmful stereotypes. In reality, those with mental health issues are more likely to be victims than perpetrators. Proper treatment and support are key to managing symptoms and reducing risks.

Mental Health Disorders and Violence

Correlation and Risk Factors

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• While there is a correlation between certain mental health disorders and an increased risk of violence, the vast majority of people with mental illness are not violent
• Most violence is caused by other factors
• Specific symptoms of mental illness, such as psychosis, paranoia, or mania, may elevate risk of violence in some cases if untreated
  • However, simply having a diagnosis does not mean a person will become violent
• Substance abuse significantly increases the risk of violence in people with or without mental illness
  • The combination of untreated mental health issues and substance abuse compounds this risk
• Social, economic, and environmental stressors can exacerbate symptoms of mental illness and further elevate the potential for violent behavior in a small subset of individuals if proper treatment and support are lacking

Misrepresentation and Stigma

• The relationship between mental illness and violence is often misrepresented in media and popular culture, leading to harmful stereotypes and stigma
  • In reality, people with mental illness are more likely to be victims of violence than perpetrators

Mental Health Conditions and Violence

Mood and Anxiety Disorders

• Depressive disorders are generally not linked to violence
  • In rare cases, severe depression can lead to self-harm or suicide, which may endanger others
  • Postpartum depression slightly elevates risk of violence toward the infant
• Anxiety disorders alone do not increase risk of violence
  • Extremely severe, untreated anxiety could potentially lead to unpredictable or erratic behavior
• Bipolar disorders may increase risk during severe manic episodes which can cause impulsivity, rage, or delusions
  • This is more likely when mania includes psychotic features

Psychotic and Personality Disorders

• Schizophrenia and other psychotic disorders elevate risk if the person experiences command hallucinations, severe paranoia, or delusions that make them feel threatened and not in control
  • Untreated psychosis is particularly concerning
• Personality disorders such as antisocial personality disorder and borderline personality disorder are associated with impulsive aggression and a higher risk of violence, often in combination with substance abuse

Trauma-Related Disorders

• Trauma-related disorders like PTSD can lead to violent outbursts, especially with re-traumatization or severe dissociative symptoms
• Childhood trauma increases risk of perpetrating violence in adulthood

Impact of Untreated Mental Health

Lack of Treatment and Insight

• Lack of access to mental health treatment, non-adherence to treatment, and inadequate care increase the risk of violent behavior in those with predisposing mental illness symptoms
• Untreated psychosis, whether in schizophrenia, bipolar disorder, depression, or drug-induced states, is one of the most significant risk factors for violence when combined with other environmental stressors
• Anosognosia, or lack of insight into one's mental illness, is a key reason people don't seek treatment and is strongly associated with violence risk
  • This is often seen in schizophrenia and bipolar disorders

Unaddressed Trauma and Worsening Symptoms

• Unaddressed trauma, especially early childhood trauma and abuse, can lead to psychological damage that increases risk of aggression and violence if not healed
  • Hurt people hurt people
• Depressive episodes or suicidality that are not adequately treated are associated with murder-suicides and familicides, though these are rare events
  • Proper treatment could prevent these tragedies
• Without treatment, mental illness often worsens over time and symptoms become more severe and harder to manage
  • Early intervention and consistent care is crucial for positive outcomes

Strategies for Addressing Mental Health Concerns

Access to Quality Care

• Increasing access to affordable, quality mental health services and reducing barriers to treatment is essential
  • This includes inpatient care, outpatient therapy and medication management, and crisis intervention
• Implementing comprehensive screening and risk assessment tools to identify those with violent tendencies and get them into appropriate treatment programs
  • This is important in healthcare, criminal justice, and school settings
• Promoting adherence to treatment plans through education, support, and follow-up
  • This may include assisted outpatient treatment programs for those who struggle with treatment compliance and are at risk

Trauma-Informed Approaches and Reducing Stigma

• Utilizing a trauma-informed care approach that addresses the impact of adverse childhood experiences and provides healing and coping strategies to reduce aggression
• Combating social stigma and discrimination that prevents people from seeking help for mental health issues
  • Public awareness campaigns and education are needed

Policy and Prevention Efforts

• Advocating for policies that prioritize mental health funding, decriminalize mental illness, and provide alternatives to incarceration for offenders with mental disorders so they can get proper care
• Implementing threat assessment teams and violence prevention programs that identify and intervene with at-risk individuals, especially in schools and workplaces
• Restricting access to lethal means, such as firearms, for people with serious mental illness symptoms that increase risk of violence
  • Extreme risk protection orders can help