<<< This is a guest blog – actually a ‘re-blog’ – by Dr Jez PHILLIPS, senior lecturer in Forensic Psychology at the University of Chester. Reproduced with his permission, I’d nevertheless direct you to his blog for yourself, replete with insight and resources which are well worth a look. He’s also starting a fascinating piece of research on police officers who tweet. >>>
The relationship between mental health and crime, as with that between the brain and crime, is one that is both complex and controversial. The media has, unfortunately, often represented this link in a negative way, leading to the perception that people committing certain types of offences are all mentally ill. This is, of course, far from the case. Yes, some individuals with mental health problems do commit serious crime, there is no doubt about that. But far more people who suffer with these conditions don’t, and pose no danger to other people at all. The misperceptions and misunderstandings that surround the links here do, I believe, really need to be tackled so as to reduce the stereotyping that is so often thei result.
In my drive to provide people with information to make up their own minds, I have listed more articles and resources on this issue below. The same problems often occur in research that examines these links as I mentioned in an earlier post. Studies are often correlational in nature and therefore causality is almost impossible to infer. And yet these studies are often wrongly portrayed as ‘proving’ links when in fact they do no such thing.
So another complex issue here and one that, rightly, causes a huge amount of debate and comment. I hope the links here help improve your understanding of this issue and perhaps inform your own thinking on it.
Article and report links:
Misconceptions, crime and mental health disorders. Excellent article here http://www.mentalhealthy.co.uk/news/512-misconceptions-crime-and-mental-health-disorders.html
A Review of the relationship between mental disorders and offending behaviours. http://www.criminologyresearchcouncil.gov.au/reports/mullen.pdf
Dangerousness and mental health: the facts. Excellent resource from MIND here http://www.mind.org.uk/help/research_and_policy/dangerousness_and_mental_health_the_facts
The relationship between mental disorders & different types of crime. Useful research abstract from last year here: http://onlinelibrary.wiley.com/doi/10.1002/cbm.819/abstract
Gender, Mental Illness and Crime. Useful and thorough US report here http://www.ncjrs.gov/pdffiles1/nij/grants/224028.pdf
Severe Mental Illness Alone Does Not Predict Violent Crime. More input into the debate here http://www.medscape.com/viewarticle/587839
Violence and mental illness: an overview. A useful article from 2003 here. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/
The link between mental health problems and violent behaviour. Excellent article from Nursing Times. http://www.nursingtimes.net/nursing-practice-clinical-research/the-link-between-mental-health-problems-and-violent-behaviour/204481.article
Schizophrenia does not influence risk of violent crime. Useful short article here http://psychcentral.com/news/2009/05/21/schizophrenia-does-not-influence-risk-of-violent-crime/6016.html
Winner of the President’s Medal,
the Royal College of Psychiatrists.
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All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
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Mental Health Cop 
This is a useful contribution to a much needed debate – but it only seems to present one side of the argument. Of course the link between violence and mental illness is complex and controversial – but I don’t think anyone is actually arguing that “ALL people committing certain types of offences are mentally ill”. But undoubtedly some are.
The danger in posting a host of articles which all seem to minimise the scale and nature of the violence by people with mental illness (in an understandable, yet in my view misguided, attempt to counter stigma) just means that people don’t really engage with the issue.
And if violence does occur, then the people having to deal with it are unprepared and often don’t deal with it very well.
There is more violence in mental health settings than in any other sector of the NHS with around 40,000 physical assaults on staff each year.
Click to access 2010-11_NHS_Violence_Against_Staff_FINAL_01-11-2011.pdf
There are around 100 homicides by people with mental illness in the United Kingdom each year – many involving very vulnerable people – the elderly, young children and at times other mental health patients.
There are many scientific studies which amply demonstrate the links between mental illness and violence.
http://www.hundredfamilies.org/TheProblem/MentalViolence/evidence.htm
The rate is particularly acute for those people who have mental illness and co-exiting substance abuse problems. In the Bristol area for instance, (according to the Medical Director of the local MH Trust) around 80% (eighty per cent) of MH patients have co-existing substance abuse problems. Such problems are not uncommon around the country.
And let’s not forget the very many MH patients who turn the violence in on themselves.
It’s easy (and lazy) just to blame the media. It means we avoid thinking about the problem and rather than helping the debate, it just hinders it.
I find your posts and views on violence and mental health to be misleading.
My understanding, as far as violence in NHS settings, is that the vast majority of incidents in mental health settings involve elderly people. I’m not trying to lessen that in any way – but I think there is something separate about hitting out by ‘frail’ elderly patients experiencing dementia and other challenges. To bring this into discussions around homicide is intentionally misleading and creates stigma.
Surely the issue is whether the posts are, in fact, misleading? … which is quite different. Although there is some research, including specifically on violence in NHS settings, there is not much and some of what is there isn’t great. I’m not sure it’s possible to be definitive without more but there is at least some research (properly done) which implies a causal relationship between serious violence and earlier, less serious violence. This is not just true of people suffering mental health problems, but generally.
In reply to Kmachin
In 2008 the Royal College of Psychiatrists and the then Healthcare Commission published an extensive and wide ranging ‘National Audit of Violence’ in Mental Health settings.
It’s certainly true that they did find a high degree of violence in wards for older people. Some 64% of nurses in those wards reported being physically assaulted during the course of their work.
However in wards for adults of working age, some 46% (i.e. nearly half) of all nursing staff also reported being physically assaulted.
Part of the reason for the difference was that improvements had been made to the management of violence on wards for working age violence which were yet to be implemented on older wards.
The report said:
“Findings from the audit showed that across England and Wales, in mental health services for adults of working age, levels of experienced violence was high. Many respondents reported not only a heightened frequency of incidents, but also an increased severity – in extreme cases involving weapons. People who had been exposed to violence described its impact, often in graphic terms.”
National Audit of Violence 2006–7 – Working Age Adult Services p 14
Click to access WAA%20Nat%20Report%20final%20with%20all%20appendices.pdf
The report said the impact on staff and patients was “constant and intolerable”
Both reports can be downloaded at
http://www.rcpsych.ac.uk/quality/qualityandaccreditation/psychiatricwards/aims/nationalauditofviolence/navnationalreports.aspx
If anyone knows of more recent or exhaustive data I’d be interested to know.
Do you know what is counted as ‘violence’ in these studies and mental health settings in general?
The reason I ask is because I have ‘violence’ scrawled all over my records yet I have NEVER been violent – and the only ‘violence’ they have witnessed is against myself – ie. self-harm.
A friend who knows a bit (professionally) about the mental health system seemed to think that they count ‘agression’ as ‘violence’. This does not mean I was squaring up to them or anything, just quite angrily telling them what I thought of them.
They seem to be allowed (unofficially?) to exclude people from services and certainly not to let the crisis team visit (yet still let a CPN come alone to my house?!) if they have labelled people as ‘violent’. With ever increasing financial and time pressures, it must be tempting to label people this way. (please see case of Joe Paraskeva)
Anyway, my point is that I can envisage many situation where the MH professionals are tutting and ticking the box marked ‘violent’ when the situation is far from it. In addition, I think we need to remember that people in a mental health setting are experiencing terrible things, and often locked up against their will.
I have witnessed mental health nurses and others do some terrible things, and actually seem to provoke their patients. Patient is then violent? – brilliant, off your case-load!
So is there a definition of violence and is it being used correctly?
I am aware of Joe’s case (and have blogged about it) and I’m also aware that patients labelled violent or challenging often dispute accuracy and it can affect their care pathways in future.
The easy answer is, because they are health based records; it is difficult to say. Certainly the police would be talking about actual assaults, based upon convictions or information which had led to someone’s diversion from justice.
I read your comment with a sinking feeling, because I can see EXACTLY what you’re getting at there. There was an interesting comment on a recent blog – forgive me I can remember which one, but I’ll see if I can look it up – by a forensic toxicologist(!) who commented upon MH services being unaware of their own impact factors to provoke or fail to de-escalate violence and that services were too quick to call the police.
That may or may not be right – clearly, officers police what is in front of them when they attend the calls that get made.
Does that help?!
The NHS body which draws up the figures (the Security Management Service) gave me the following definition of violence they use –
“The intentional application of force to the person by another without lawful justification, resulting in physical injury or personal discomfort”
so presumably just getting angry, without physical assault, shouldn’t be included in these figures.
I think it was reasonably clear from the Royal College of Psychiatrist’s study that where de-escalation techniques and practices had been introduced onto wards, the scale of violence noticeably reduced.
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The Theme is called “The Morning After” and it’s on the wordpress support site. Developed bya company called “Woo Themese” – hope that helps?! Thanks for the feedback on the blog, always welcome! Not sure what to suggest on the iPhone problem … I have an iPhone 4 and it shows up fine on there.
The problem with the recording of violence on wards is that there is no real corroboration or need for evidence. A nurse writes it in the notes, it becomes fact and other staff members can back it up when they weren’t even present. And nobody questions it. But the patient has it recorded as a fact on their notes for the rest of their life.
And I’ve seen staff do things that are regarded as violent and/or abusive (I used to work in the NHS) and complaints not followed up, or dismissed out of hand. And when it comes to provocation, some RMNs are experts. They should not be protected by the system, it undermines good work by their colleagues and confidence in MH care.
RMNs need certain powers to fulfil their roles, especially in secure units. However, they should not automatically be taken at their word and the people they are supposed to be caring for should not be ignored.