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Violence and Mentally Ill

Armen Hareyan's picture

Mental Health

In an editorial accompanying the article, Leon Eisenberg, M.D., of Harvard Medical School, Boston, writes, "Stigma against mental illness turns the world on its head. Blaming the victims rationalizes neglect and maltreatment. In the public mind, violence is associated with mental illness. Yes, there is a strong association, but the direction of causality is the reverse of common belief: persons who are seriously mentally ill are far more likely to be the victims of violence than its initiators. The evidence produced by Linda Teplin et al settles the matter beyond question."

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Dr. Eisenberg points out that although life in the community is precarious for persons with serious mental illness, institutions also have safety issues and most persons with severe mental illness express a preference for community living. "What should be done?" Dr. Eisenberg writes. "Teplin and colleagues make thoughtful recommendations. For patient care, they propose systematic screening and monitoring patients for victimization (commonly not reported to case managers), implementing skill-based prevention programs to help patients learn to minimize risk, and interventions to reduce revictimization. At a policy level, they call for building collaborative relationships between the mental health and criminal justice systems and advocacy for improved housing."

"These proposals are on target but do not go far enough," Dr. Eisenberg concludes. "The underlying lesson is that the neighborhoods in which patients are forced to live because of limited income are what make them so vulnerable. Patients with severe mental illness who live in urban slums are victimized by 'legal' criminals as well: moneylenders who charge exorbitant interest rates, hotel keepers who demand bribes for rooms, bullies who accost them for money when Supplementary Security Income checks are issued, and police who do not defend them. The aggregation of persons who are seriously mentally ill in urban areas that are not safe for any inhabitants, let alone for those at cognitive disadvantage, is why rates of victimization are so high."

(Arch Gen Psychiatry. 2005;62:825-826.)