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Abstract
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The question of the nature and magnitude of the association between schizophrenia and risk of violence perpetration has been the subject of considerable research and wider public interest. It is a complex relationship, and important to clarify for people with mental illness and their families, with implications for health policy, mental health law, criminal justice, and public mental health. It therefore requires careful, evidence‐based consideration.
Over the last decade, complementary epidemiological study and trial designs have provided triangulation of evidence on the association between schizophrenia and violence. These studies have shown robustly two main findings: that there is an elevated risk of violence in schizophrenia spectrum disorders, and that the absolute level is not large (and only a minority of people with severe mental illness will perpetrate serious violence over their lifetime). Another replicated research finding is that the violence perpetration risk is further increased if other factors, such as substance misuse comorbidity and previous violence perpetration and victimization, are also present. In addition, it has been clearly shown that widely available evidence‐based treatments can reduce the risk.
The risk of perpetrating violence is not imminent or significant in most people with schizophrenia, but it is not so small that it can be ignored. Given its relevance to public perceptions of dangerousness and stigma, we agree that the evidence needs careful communication 1 . However, a simplistic approach which states that recognizing any association between violence and schizophrenia will inevitably be damaging for efforts to reduce stigma is problematic. It fails to take account of the evidence as a whole, presupposes that communication of the link cannot be undertaken without worsening stigma, and overlooks the lived experience of people for whom the impact of schizophrenia is compounded by the related perpetration of a violent offence.
Here, we present an alternative way forward, that: a) recognizes the findings of triangulated and replicated research evidence, that has considered key confounds, but properly contextualizes relative risks with information on absolute rates, and b) highlights that the implication of these findings is to improve clinical assessment, treatment and management of violence risk, which will be the most effective way to reduce associated stigma.
Language: en |