Presented at Music City Tackles Mental Health, March 5, 2018 by Kimberly Brown, PhD, ABPP

1. Kimberly Brown, Ph.D., ABPP
Vanderbilt University Medical Center
March 2018
Violence and
Mental Illness

2. Assault (misdemeanor)
 Case A –
◦ Dx of Schizophrenia, believes mother is shooting
electromagnetic rays into his brain while he sleeps,
hits her
 Case B
◦ Dx of Schizophrenia, coming off high, needs more
money, mother won’t give it to him, he hits her
 Case C
◦ No Dx, gets into argument with mother about his lack
of job, he hits her

3. Myths
 Surveys indicate that public estimates that 75% of
people with mentally ill are dangerous
 Opinion poll in 2013:
◦ 60% of the U.S. believes that people with
schizophrenia are likely to be violent
Reality
 Per Swanson, Curing major mental illness would
reduce serious violence by 4%. Meanwhile, 3.5
million people with serious psychiatric disorders go
without treatment.

4.  Compared to who?
◦ General population without mental illness
◦ Violent offenders being released from prison
 What does mentally ill mean?
 In what context/situation?
 Are we asking the wrong question?
◦ (Individual + Situation + Symptoms)

5.  Slightly more likely to commit violence than the
general population
 Less likely than many other populations (criminals,
just substance abuse, just personality disorders)
 Severe mental illness is not an independent
contributor to violence
 Factors that predict violence in general also predict
violence individuals with mental illness
 “Terrible 3’s”
 History of Violence, Substance Use, Young

6.  The combination of substance abuse and
mental illness is a very bad one
 Even worse – triad of severe mental illness,
substance use, and history of violence
Mental Illness History of Violence
Substance Use

7. 1. Vast majority of violence is not committed
by the mentally ill
2. Vast majority of mentally ill are not violent
3. Mentally ill are more likely to harm
themselves than others (suicide)
4. Mentally ill are more likely to be victimized
than harm others
5. Risk Factors for mentally ill are similar to
non mentally ill
6. Small subset of mentally ill whose symptoms
of mental illness directly cause their violent
acts

8.  Prioritize based on need/risk
 Aggressive treatment and monitoring in the
community (medication adherence)
 Treat drug and alcohol addiction
 Psychiatric hospitalization during periods of
symptom exacerbation
 Limit or eliminate access to weapons and substances
 Reduce stress and increase positive social support
 Reduce victim availability
 Provide vocational training/employment
opportunities

9.  Rarely is violence in the mentally ill caused by the
mental illness - cofactors
 There is a very small group of mentally ill individuals
who are disproportionately at risk for violent acts
 We can do something about this (sometimes prevent,
but often manage)
 Look beyond diagnosis to:
◦ Symptoms + Individual + Situation/Context