Violence and Victimization
Most people with severe mental illness are not violent, and violence by people with severe mental illness contributes little to the overall rate of violence in the community. A review of violence among people with severe mental illness did indicate, however, that violence perpetration is more common among people with severe mental illness compared with the general population (Choe et al., 2008). Rates of perpetration were highest among committed inpatients, whose violent acts were likely to have preceded an involuntary hospitalization. During an episode of psychosis, particularly if accompanied by paranoia and command hallucinations, the risk of violence is greater among people with severe mental illness (Insel, 2011). In the presence of substance use disorder and poor adherence to medication treatment, the risk of violence can be increased substantially (Swanson, 1994; Swartz et al., 1998).
Violent victimization is more common among people with severe mental illness than in the general population. Studies of patients with severe mental illness indicate that 25 to 35 percent had been a victim of violence in the past year (Choe et al., 2008; Teplin et al., 2005). Compared to the general population, the one-year rate of victimization among people with mental illness is 11 times higher (Teplin et al., 2005). There is a high incidence of victimization among homeless people associated with their lifestyle and marginality (Lee & Schreck, 2005). Victimization among homeless people with severe mental illness is higher than that found among housed adults with severe mental illness (Roy et al., 2014). Moreover, homeless women are more likely to be victims of violent crimes such as physical abuse and sexual assault (Brunette & Drake, 1997; Cheng & Kelly, 2008; Sullivan et al., 2000).