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Henry J. Steadman, PhD; Edward P. Mulvey, PhD; John Monahan, PhD; Pamela Clark Robbins, BA; Paul S. Appelbaum, MD; Thomas Grisso, PhD; Loren H. Roth, MD; Eric Silver, MA

Arch Gen Psychiatry. 1998;55:393-401.

Background  The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed.

Methods  We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks.

Results  There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home.

Conclusions  "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

From Policy Research Associates Inc, Delmar, NY (Dr Steadman, Ms Robbins, and Mr Silver); University of Pittsburgh School of Medicine, Pittsburgh, Pa (Drs Mulvey and Roth); University of Virginia School of Law, Charlottesville (Dr Monahan); and University of Massachusetts Medical School, Worcester (Drs Appelbaum and Grisso).

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