It's hard to come up with hard numbers, but these, below, are the best ones I can find about the risk of violence from psychotic people where the risk is put in percentage of the psychotic people who are violent and the effects of medication on the risk.
Keep in mind that some of these numbers are for habitual violence, some for violence in the past year or past four months, some for what percent had criminal convictions.
It's pretty hard to reasonably extrapolate a lifetime risk for a psychotic person to be violent from the available research.
But it's pretty darned sure that not taking your meds increases that risk *a lot*.
So if you're psychotic and don't want to go to jail, take your meds.
If your loved one is psychotic and you don't want them to commit awful crimes and go to jail, they need to take their meds.
The overwhelming consensus of research psychologists and research psychiatrists---who frequently work in academia and don't exactly have an incentive to get themselves more patients, as has been suggested----is that meds are strictly necessary to reduce the risk of violence in psychotic people.
The belief in "alternatives" as treatment for psychoses is very much a fringe belief.
Fringe beliefs have been right in the past when the mainstream was wrong----but it's not the way to bet.
Betting your life and the life of your loved ones and sometimes the lives of total strangers on the chance the fringe might be right this time would be a bad idea.
In the *abstract*, *hypothetically*---sure, play around with the idea that there might be non-medication treatments that can be developed that are effective. But when you get down to real life cases based on what we know today, not giving your loved one psychiatric meds if she's psychotic is like praying over her bed instead of allowing a transfusion when she's been in a car wreck---or refusing to let her take the measles vaccine when there's an active measles outbreak in the community.
Yeah, sure, if there's no outbreak where you are, and you buy some of the links between mercury and autism, okay, sure, yada yada yada on the whole vaccine thing. But when there's an outbreak right there in your community, you let the hypothetical people play in the fringe and you go down and get your kid the shot.
Yeah, sure, if your kid isn't actively psychotic, talk about the alternatives all you want, yada yada yada. But if your kid is having delusions and halucinations you let the hypothetical people play in the fringe, and you bite the bullet and give your kid the meds.
Playing in the fringe has risks, and a lot of times they're much more serious risks than the actual treatment the fringe folk see as such a bogeyman.
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* A study of 133 outpatients with schizophrenia showed that "13 percent of the study group were characteristically violent." Having inadequately treated symptoms of delusions and hallucinations was one of the predictions of violent behavior. Specifically, "71 percent of the violent patients?had problems with medication compliance, compared with only 17 percent of those without hostile behaviors," a difference which was statistically highly significant (p< 0.001).
Bartels J, Drake RE, Wallach MA, et. al. Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin 17:163-171, 1991.
* In a follow-up of patients released from a psychiatric hospital, Dr Henry Steadman et. al. reported that "27 percent of released male and female patients report at least one violent act within a means of four months after discharge."
Monahan J. Mental disorder and violent behavior. American Psychologist 47:511-521, 1992.
* A study of 348 inpatients in a Virginia state psychiatric hospital found that patients who refused to take medication "were more likely to be assaultive, were more likely to require seclusion and restraint, and had longer hospitalizations."
Kasper JA, Hoge SK, Feucht-Haviar T, et. al. Prospective study of patients? refusal of antipsychotic medication under a physician discretion review procedure. American Journal of Psychiatry 154:483-489, 1997.
* A 10-year follow-up of 1056 severely mentally ill patients discharged from mental hospitals in Sweden in 1986 reported that "of those who were 40 years old or younger at the time of discharge, nearly 40 percent had a criminal record as compared to less than 10 percent of the general public." Furthermore, "the most frequently occurring crimes are violent crimes."
Belfrage H. A ten-year follow-up of criminality in Stockholm mental patients. British Journal of Criminology 38:145-155, 1998.
* A study of 331 individuals with severe mental illness reported that 17.8 percent "had engaged in serious violent acts that involved weapons or caused injury." It also found that "substance abuse problems, medication noncompliance, and low insight into illness operate together to increase violence risk."
Swartz MS, Swanson JW, Hiday VA, et. al. Violence and severe mental illness: The effects of substance abuse and nonadherence to medication. American Journal of Psychiatry 155:226-231, 1998.
* A four-state (NH, CT, MD, and NC) study of 802 adults with severe mental illness (64 percent schizophrenia or schizoaffective disorder, 17 percent bipolar disorder) reported that 13.6 percent had been violent within the previous year. ?Violent? was defined as ?any physical fighting or assaultive actions causing bodily injury to another person, any use of lethal weapon to harm or threaten someone, or any sexual assault during that period.? Those who had been violent were more likely to have been homeless, to be substance abusers, and to be living in a violent environment. Those who had been violent were also 1.7 times more likely to have been noncompliant with medications. As has been found in other such studies, the women with severe psychiatric disorders were almost as likely to have been violent (11 percent) as were the men (15 percent). Because the data on violent behavior were collected by self-report, the authors suggested ?that our findings are probably conservative estimates of the true prevalence of violent behavior for persons with SMI.? They concluded ?that risk of violence among persons with SMI is a significant problem? and ?is substantially higher than estimates of the violence rate for the general population.?
Swanson JW, Swartz MS, Essock SM et al. The social-environmental context of violent behavior in persons treated for severe mental illness. American Journal of Public Health 92:1523-1531, 2002.
* In reviewing many of these studies in 1992 Professor John Monahan concluded: "The data that have recently become available, fairly read, suggest the one conclusion I did not want to reach: Whether the measure is the prevalence of violence among the disordered or the prevalence of disorder among the violent, whether the sample is people who are selected for treatment as inmates or patients in institutions or people randomly chosen from the open community, and no matter how many social and demographic factors are statistically taken into account, there appears to be a relationship between mental disorder and violent behavior."
Monahan J. Mental disorder and violent behavior. American Psychologist 47:511-521,1992.
* There is very little data which can be used to estimate the percentage of severely mentally ill individuals who become violent. The best study used the Danish psychiatric case register, covering the whole country, and convictions for criminal offenses. Between1978 and 1990 6.7 percent of males and 0.9 percent of females with "major mental disorders" (psychoses) were convicted of a violent crime ("all offenses involving interpersonal aggression or a threat thereof"), compared with 1.5 percent males and 0.1 percent females among individuals with no psychiatric diagnosis. Since these are only convictions, it can be assumed that another unknown percentage committed a violent act for which they were not charged or convicted.
Hodgins S, Mednick SA, Brennan PA, et.al. Mental disorder and crime. Archives of General Psychiatry 53:489-496, 1996.
* The incidence of violent behavior among severely mentally ill individuals in the studies discussed under II above includes:
o 11 percent in the survey of NAMI families
o 13 percent among outpatients with schizophrenia
o 8.9 percent in treatment and 17.4 percent not in treatment in the MacArthur Foundation Study
o 17.8 percent among inpatients with severe mental illness
* In light of the above, it seems reasonable to estimate that at least 10 percent of males with a severe mental illness exhibit violent behavior at some time during their illness and a lesser percentage of females. Since there are at least 4 million individuals in the United States with schizophrenia and manic-depressive disorder, then approximately 200,000 ? 250,000 severely mentally ill individuals are or have been violent.
Timoclea
Here's the site:
http://www.psychlaws.org/BriefingPapers/BP8.htmI hold it to be the inalienable right of anybody to go to hell in his own way.
--Robert Frost, American poet
