More than one fourth of individuals with severe mental illness (SMI) were victims of violent crime in the past year

Aug 1 2005

More than one fourth of individuals with severe mental illness (SMI) were victims of violent crime in the past year, eleven times the rate in the general population, according to a study in the August issue of Archives of General Psychiatry.

Prior studies suggest that individuals with mental disorders who live in the community are a vulnerable population at high risk of becoming victims of crime, according to background information in the article. Symptoms associated with severe mental illness, such as disorganized thought processes, impulsivity and poor planning and problem solving may compromise one's ability to perceive risks and protect oneself, the authors suggest. Other factors correlated with victimization, including substance abuse, conflicted social relationships, poverty and homelessness, are also common among persons with severe mental illness.

Linda A. Teplin, Ph.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues administered the National Crime Victimization Survey (NCVS) to 936 randomly selected patients from 16 outpatient, day or residential mental health agencies in Chicago, comparing the results to data from the 32,449 participants in the annual NCVS conducted by the Bureau of the Census for the Bureau of Justice Statistics. The surveys of the individuals with severe mental illness were conducted by clinical research interviewers with master's level training.

"Over one quarter of the SMI sample had been victims of a violent crime (attempted or completed) in the past year, 11.8 times higher than the NCVS rates; nearly 17 percent of the SMI sample had been victims of completed violence," the authors report. "More that 21 percent of persons with SMI had been victims of personal theft (theft of an item from one's person), more that 140 times higher than the NCVS rates. … Nearly 28 percent of persons with SMI had been victims of property crimes, approximately four times higher than the NCVS rates."

"In the general population, crime victimization can cause anxiety, depression, substance use disorders, and post-traumatic stress disorder," the authors write. "Among persons with mental disorders, victimization can exacerbate existing disorders, increase the likelihood of service use and hospitalization, and substantially diminish quality of life. Moreover, victimization increases the likelihood of revictimization and is associated with perpetration of violence among persons with SMI, just as in the general population."

"Among persons with SMI, violent victimization is far more prevalent (more that 25 percent within one year in this study) than perpetration of violence (4 percent – 13 percent)," the authors write. "Crime victimization among persons with SMI must be addressed the same way as other health disparities are addressed: by using all available tools and resources to reduce the risks and consequences of this public health problem."

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."

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."

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