Research into practice

It is a common assumption among the public that people with
mental health problems pose a significant risk of violence. A
recently published article by Elizabeth Walsh and Thomas Fahy
explores whether there is any research to challenge this
assumption.¹

They quote a US study, based on self-reporting of violence,
which showed that 8 per cent of people with schizophrenia reported
being violent compared with 2 per cent of those with no psychiatric
disorder. They also refer to an Australian study that showed a
similar ratio of four to one for men with schizophrenia who had
been convicted for offences of serious violence.

However, the authors rightly argue that it is necessary to see
these figures in context. They ask the important question “what
proportion of societal violence is attributable to mental
disorder?” Their answer is that other variables are far more
significant than mental health problems: “Variables such as male
sex, young age, and lower socio-economic status contribute a much
higher proportion to societal violence than the modest amount
attributable to mental illness”.

They go on to argue that less than 10 per cent of serious
violence, including homicide, is attributable to psychotic
conditions. And, they add, where such violence does occur on the
part of someone with psychosis, it is only in a small minority of
cases that a stranger is the victim. So, it appears that there is
little support for the populist association of mental disorder with
violence in general or community violence in particular. Indeed,
the authors point out that drug and alcohol abuse is a much more
significant indicator of potential violence than mental
illness.

Although there are risks to do with violence associated with
working with people with mental health problems we should not allow
ourselves to be influenced by discriminatory stereotypes which
exaggerate the risk and, in so doing, treat people with mental
health problems unfairly. The term “mentalism” has not become as
well-established as other terms relating to discrimination, such as
racism, sexism, ageism or disablism. But this is not to say that
discrimination against people with mental health problems is not
widespread, but rather that it has not been fully recognised.

The research that Walsh and Fahy draw upon in this article helps
to establish that the notion that people with mental health
problems present a high risk of violence is not a reliable one.

The view of people with mental health problems as posing a
significant risk of aggression and violence is part of what has
become a “moral panic’”about law and order. It feeds into
public concern about the “problem” of community care and
contributes a great deal to false impressions which can distort the
reality of people’s lives and the responses of professional
staff. Being subjected to violence is a serious concern for all
those working in the social care sector, and so we need to be able
to evaluate risks properly.

However, what we should not do is allow anxieties about avoiding
violence to lead us to rely on dangerous and discriminatory
stereotypes.

Neil Thompson is a director of Avenue Consulting (www.avenueconsulting.co.uk) and
a visiting professor at the University of Liverpool. He is the
author of People Skills (2nd edn, Palgrave Macmillan,
2002).

¹ Elizabeth Walsh and Thomas
Fahy, “Violence in Society”, British Medical Journal,
2002.