Mental Health and Violence

Is the public at risk?

We have learned that substance abuse increases the violence of mentally ill individuals, but who are their target? Studies and research suggest there are several catalyst or conditions that may trigger extremely violent attack by those that are mentally ill. These conditions are often linked to conditions in their social life, and closest social interactions. In the MacArthur violence risk assessment study likely recipient of violence are family members (87%) and the violence typically started or occurred at the home. Mentally ill patients were less likely 10% to target complete strangers compared to community members 22%. In many of the mass violent crimes we have experience in the last 5 years, if the crime does not occur at home, it occurs within the community of the attacker.


What are the signs to look for as a parent, neighbor, or friend?

History of violence:

A past history of violence maybe a telling sign of future risks and violent behaviors. Mentally ill individuals that have a history of violence or aggression may be at increase risk to exhibit future violent and aggressive behaviors.

Substance Abuse Problems:

Drugs, alcohol, and other substances significantly increase the likelihood of violence. Drugs and alcohol increase the risk of violence in any individual, however with mentally ill individuals these factors significantly act as determinants of violence.


Homelessness, lack of social support, bullying, and family stress are factors suggested to contribute towards violent behaviors.


Studies have shown that young males with mental illness have a higher risk factor for associated violence.


In analyzing this study in the wake of the Sandy Hook shooting here are some key findings based on data and not raw emotions.

1)   Having a mental health/illness issue or a social disorder does not cause an individual to be violent or infer and individual will commit a violent act.

2)   The number of mentally ill individuals that commit act of violence compared to non mentally ill individuals are indistinguishable and very small.

3)   Family members are usually the first recipients of violence.

4)   Complete strangers are less likely to experience violence from a mentally ill patient compared to members of their community, social circle or family.

5)   Substance abuse appears to be a large determinant in violence, and management of substance abuse disorders among seriously mentally ill patient may help prevent violence.

As we mourn the lives of the 26 and countless others that have been taken as a result of violence, we have to remember the heinous crimes were the act of a few mentally ill individuals and that being mentally ill does not make you violent. As members of various communities its up to us to be aware of some of these signs listed above, we may witness these signs in our communities, home or neighbors.  It’s imperative we going beyond contacting our lawmakers, and look at we can do to help prevent some of these violent crimes, we never know when the violence will come knocking on our door.

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1. Monahan J. Steadman HJ. Silver E, et al. Risk assessment: the MacArthur Study of Mental Disorder and Violence. Oxford: Oxford University Press; 2001.

2. Applebaum PS. Robbins PC. Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000;157:566–572.

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