Comments and Controversies
Mental illness and violence
I am writing in response to Dr. Henry A. Nasrallah’s “Integrating psychiatry with other medical specialties” (Current Psychiatry, September 2010, p. 14-15). Although it is unfortunate that many individuals with severe mental illness have ended up in the criminal justice system, often it is unavoidable. Since deinstitutionalization, many of these people live freely in society. Persons with severe mental illness, especially when untreated, are more violent than the general population.1-3 The key to destigmatizing mental illness is not to deny this truth, but to facilitate a better system of community mental health so that these individuals are treated early in the course of their illness and do not become wards of the state.
Brian Hernandez, MD
1. Large M, Smith G, Nielssen O. The relationship between the rate of homicide by those with schizophrenia and the overall homicide rate: a systematic review and meta-analysis. Schizophr Res. 2009;112:123-129.
2. Swanson JW. Mental disorder substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago, IL: University of Chicago Press; 1994: 101-136.
3. Yee NY, Large MM, Kemp RI, et al. Severe non-lethal violence during psychotic illness. Aust N Z J Psychiatry. 2010. [Epub ahead of print]
Dr. Nasrallah responds
Our patients are only occasionally incarcerated for violent acts. Most of the seriously mentally ill are taken to jail for disturbing the peace or acting in a bizarre manner, such as being intoxicated. When we had ample psychiatric beds, these patients were hospitalized and treated with dignity as sick people. Now they are criminalized and taken to jails and prisons. If states had spent money on building modern psychiatric facilities instead of jails, there would not be crowding of correctional facilities in our country compared with many other countries. In the past, maximum-security units existed in hospitals, not only in jails and prisons.
Henry A. Nasrallah, MD