This issue of Psychiatric Services is about violence and mental illness. It addresses behavioral extremes perpetrated by people with a mental disorder but more often perpetrated against them—by individuals and by society. The articles, brief reports, and commentaries in this issue deal with risks and realities, services and policies, actions and responses. Although we sometimes plan and create special issues by working with a particular group of authors, this issue accumulated quickly from unsolicited manuscripts submitted over several months. As such, this issue reflects the concerns and interests of the times in which these papers have been written.
I was drawn to psychiatry and mental health policy because of the field's awareness of social context and the importance given to patient care and services. We are concerned about the recovery of individuals diagnosed as having a mental disorder, and we must protect them from harm. But we also have an obligation to protect society from dangers that might be associated with mental illness. Psychiatric services is not the only area of medicine and human services in which concern about social issues is evident and in which the balance between personal liberty and societal protection is a focus. Patients with general medical conditions are restrained in nursing homes and hospital beds, observed for involuntary treatment of drug-resistant tuberculosis, and quarantined to protect society against infection. However, in psychiatric services these issues are considered more frequently than in most other human services. Historically our society has been more concerned about its own protection than about the protection of psychiatric patients. To partly redress this, in recent policy statements leaders in the mental health field have placed the individual at the center of services.
Our field often focuses on the tension between personal liberty and societal protection. It is imperative that we get the balance right. The articles, brief reports, and commentaries in this issue address this set of concerns—the risk of violence and victimization, the proper role for seclusion and restraint and patients' preferences in regard to these practices, and rates of incarceration and homelessness and efforts to prevent these outcomes. At every turn there is the chance that we will underreact and there will be harm—or more likely, that we will overreact and a different kind of harm will result. I believe that we have an obligation to use extreme measures in the rarest of instances, when there is no alternative. When we exploit the dangers associated with mental illness to advance policy, we risk the harm of exploiting the individuals themselves.
