Violence and Mental Illness

December 2019

The relationship between violence and mental illness, as understood by the general public, is fraught with misinformation. The complexity and emotional valence surrounding violence coupled with the stigma associated with mental illness demands sound research and thoughtful dialogue. In this month’s collection, we present several articles exploring the relationship between violence and mental illness. The first section describes two risk assessment models: the COVR (Classification of Violence Risk), which is an actuarial tool, and violence risk self-assessment. The next section focuses on gun violence, presenting a Viewpoint on mental illness and gun violence and underscoring the relatively low rates of gun violence among individuals with mental illness. The following sections are organized by site of violent behavior (on inpatient units or in the community) and reveal the unique challenges of characterizing and preventing violence in each setting. The final article in this collection highlights an intervention to reduce and perhaps prevent future violence by individuals with both mental illness and criminal justice involvement.

Stephanie A. Rolin, M.D.
Lisa B. Dixon, M.D., M.P.H.

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Risk Assessment

Violent Behavior and Gender of Swedish Psychiatric Patients: A Prospective Clinical Study
Joakim Sturup, Ph.D., John Monahan, Ph.D., Marianne Kristiansson, Ph.D.
2013, Volume 64, Issue 7, pp. 688–693


The Utility of Patients’ Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best
Jennifer L. Skeem, Ph.D., Sarah M. Manchak, Ph.D., Charles W. Lidz, Ph.D., Edward P. Mulvey, Ph.D.
2013, Volume 64, Issue 5, pp. 410–415

Gun Violence

Gun Violence Following Inpatient Psychiatric Treatment: Offense Characteristics, Sources of Guns, and Number of Victims
Aaron J. Kivisto, Ph.D.
2017, Volume 68, Issue 10, pp. 1025–1031


Gun Violence and Victimization of Strangers by Persons With a Mental Illness: Data From the MacArthur Violence Risk Assessment Study
Henry J. Steadman, Ph.D., John Monahan, Ph.D., Debra A. Pinals, M.D., Roumen Vesselinov, Ph.D., Pamela Clark Robbins, B.A.
2015, Volume 66, Issue 11, pp. 1238–1241


Mental Illness and Gun Violence: Disrupting the Narrative
Emma E. McGinty, Ph.D., M.S.
2018, Volume 69, Issue 8, pp. 842–843


Extreme Risk Protection Orders to Reduce Firearm Violence
William Frizzell, M.D., and Joseph Chien, D.O.
2019, Volume 70, Issue 1, pp. 75–77

Violence in Inpatient Settings

Use of Multimodal Technology to Identify Digital Correlates of Violence Among Inpatients With Serious Mental Illness: A Pilot Study
Dror Ben-Zeev, Ph.D., Emily A. Scherer, Ph.D., Rachel M. Brian, M.P.H., Lisa A. Mistler, M.D., Andrew T. Campbell, Ph.D., Rui Wang, M.S.
2017, Volume 68, Issue 10, pp. 1088–1092


Association Between Restriction of Involuntary Medication and Frequency of Coercive Measures and Violent Incidents
Erich Flammer, Dr.Biol.Hum., Tilman Steinert, Prof.Dr.Med.
2016, Volume 67, Issue 12, pp. 1315–1320


Relationship Between Seclusion and Restraint Reduction and Assaults in Pennsylvania’s Forensic Services Centers: 2001–2010
Gregory M. Smith, M.S., Donna M. Ashbridge, R.N., M.S., Aidan Altenor, Ph.D., William Steinmetz, B.S., Robert H. Davis, M.D., Phil Mader, B.S., Dale K. Adair, M.D.
2015, Volume 66, Issue 12, pp. 1326–1332


Injurious Assault Rates on Inpatient Psychiatric Units: Associations With Staffing by Registered Nurses and Other Nursing Personnel
Vincent S. Staggs, Ph.D.
2015, Volume 66, Issue 11, pp. 1162–1166


Correlation Between Reduction of Seclusion and Restraint and Assaults by Patients in Pennsylvania’s State Hospitals
Gregory M. Smith, M.S., Donna M. Ashbridge, M.S., R.N., Robert H. Davis, M.D., William Steinmetz, B.S.
2015, Volume 66, Issue 3, pp. 303–309


Use of Security Officers on Inpatient Psychiatry Units
Ryan E. Lawrence, M.D., M.Div., Maria M. Perez-Coste, M.D., Stan D. Arkow, M.D., Paul S. Appelbaum, M.D., Lisa B. Dixon, M.D., M.P.H.
2018, Volume 69, Issue 7, pp. 777–783

Violence in the Community

Violence to Others, Violent Self-Victimization, and Violent Victimization by Others Among Persons With a Mental Illness
John Monahan, Ph.D., Roumen Vesselinov, Ph.D., Pamela Clark Robbins, B.A., Paul S. Appelbaum, M.D.
2017, Volume 68, Issue 5, pp. 516–519


Proximal Risk Factors for Short-Term Community Violence Among Adults With Mental Illnesses
Kiersten L. Johnson, M.S., Sarah L. Desmarais, Ph.D., Kevin J. Grimm, Ph.D., Stephen J. Tueller, Ph.D., Marvin S. Swartz, M.D., & Richard A. Van Dorn, Ph.D.
2016, Volume 67, Issue 7, pp. 771–778

Violence Risk Reduction

Prospective Study of Violence Risk Reduction by a Mental Health Court
Dale E. McNiel, Ph.D., Naomi Sadeh, Ph.D., Kevin L. Delucchi, Ph.D., Renée L. Binder, M.D.
2015, Volume 66, Issue 6, pp. 598–603

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