A new cross-sectional study published in the British Journal of Psychiatry has assessed the prevalence of violent victimisation amongst a group of people with severe mental illness, in comparison to a control group (Khalifeh et al, 2015).
Being a victim of crime, whether violent or non-violent, is associated with important longer term health consequences across domains (Resnick et al, 1997). In particular, victimisation is understood to drive worse clinical and functional outcomes in people with established mental illness.
In the general population, risk of victimisation is usually understood to be influenced by sociodemographic risk factors, as well as the characteristics of neighbourhoods in which people live (Brennan et al, 2010; Zedner, 2002).
Clinical experience indicates that victimisation is common among people with mental illness, particularly among those receiving intensive or longer term service contact, who are sometime defined as suffering from “serious mental illness”, or SMI, by health services.
A small number of studies have demonstrated very high prevalences of victimisation in populations with serious mental illness. For example, a 2003 study described a prevalence for violent victimization of 16% among a sample of patients with psychotic disorder (Walsh et al, 2003). However, few studies have compared these estimates with a control sample from the same underlying population as the cases.
This BJPsych study assessed the sociodemographic characteristics of victimised individuals with SMI, and compared it with a series of non-SMI controls.
Method
This report compared two surveys:
- The cases: a cross-sectional survey of patients with mental health services, and
- The controls: a national crime survey of the general population.
For the patient survey, caseload lists of patients receiving key work by community mental health team (CMHT) clinicians were randomly sampled to identify the study population. These people were then asked to participate in the study, recruited and then interviewed about their experiences of crime.
Participants were all adults in care for one year or longer, and resident in the community (not in residential care). The participants had to speak English, provide capable consent, and be available for interview.
Results
1,099 patients were randomly selected from CMHT lists. 63% were eligible, of whom 52% agreed to take part. The odds ratio for case-control status for the victim of any crime was 2.8 in favour of the cases. Of note, only personal acquisitive crime was not significantly raised among cases compared to controls.
In the evaluation of acts of violence, the investigators found more violent victimisation in the cases than the controls in both men and women, but the elevated risk in women was much greater.
Conclusions
The prevalence of victimisation in people with SMI was 40% compared with 14% in the control group. The relative excess of victimisation in SMI was particularly pronounced for females. This excess in victimisation reports was only partially accounted for by deprivation, drug use, and perpetrated violence.
Patients were five times more likely to be victims of assault, and three times more likely to be victims of household acquisitive crime. The likelihood of reporting violent victimisation to the police was similar between patients and controls.
Strengths and limitations
The authors are explicit about the limitations of the study, and the conclusions are modest. Comparisons of victimisation rates in SMI with a relevant control group are rare; this study was relatively large, and appears to have been designed with this particular study objective in mind.
The response rate was very low (nearly half of people asked to participate chose not to), but any bias introduced by this probably led the estimates of excess victimisation prevalence to be less, not more pronounced. The investigators conclusions would be unlikely to have changed had this bias not been there.
The researchers could have collected some basic characteristics of non-responders from care coordinators (e.g age, gender) in order to assess whether non-responders were very different from responders. The role of neighbourhood characteristics, which are known to consistently influence the likelihood that you are victimised (Sampson et al, 1993), was not directly measured or assessed, as the researchers investigated the questions within a single study area. The effect of area of residence on the risk of victimisation in people with SMI remains an open question.
In conclusion, this study is important. People with SMI in London are at ongoing elevated risk of harm from other people, and it’s likely that there is an urgent unmet need within the NHS mental health service user population.
Although the findings are unsurprising, it is very clear that researchers have tended to focus on mental illnesses as driving the perpetration of violence, rather than investigating why SMI populations report so much violence at the hands of other patients, and the community at large.
More descriptive data, more detailed time measurement of violence exposures, and richer measurement of the experiences of patients with SMI is crucial to developing interventions to reduce violence in these people, and to evaluate and implement them effectively.
Links
Khalifeh H, Johnson SC, Howard LM, et al. (2015) Violent and non-violent crime against adults with severe mental illness. British Journal of Psychiatry 2015:1-8 doi: 10.1192/bjp.bp.114.147843 [published Online First: Epub Date]
Resnick HS, Acierno R, Kilpatrick DG. (1997) Health impact of interpersonal violence. 2: Medical and mental health outcomes. Behav Med 1997;23(2):65-78 doi: 10.1080/08964289709596730 [First page preview]
Brennan IR, Moore SC, Shepherd JP. (2010) Risk factors for violent victimisation and injury from Six years of the british crime survey. International Review of Victimology 2010;17(2):209-29
Zedner L. (2002) Victims. The Oxford handbook of criminology 2002:419-56
Walsh E, Moran P, Scott C, et al. (2003) Prevalence of violent victimisation in severe mental illness. The British journal of psychiatry : the journal of mental science 2003;183:233-8
Sampson RJ, Lauritsen JL. (1993) Violent Victimization and Offending: Individual-, Situational-, and Community-Level Risk Factors. Understanding and Preventing Violence: Social influences 1993;3:1
Begonia Serrano
6 years agoRawsthorneMat
11 years agoMillsy_Rose
11 years agoStefanWagler
11 years agoJohnFoster12
11 years agoBuffDavis
11 years agoMorisonKay
11 years agoMerynEdwards
11 years agoLizHughesDD
11 years agoMental_Elf
11 years agodiabeticswithed
11 years agolornaj_h
11 years agoMiranda_dWD
11 years agoWonderOn
11 years agolypftlib
11 years agoArchiBerlin
11 years agorespros
11 years agogerose290
11 years agoHerne_TheHunter
11 years agoJayneMCox
11 years agoanniecoops
11 years agodrdrewdunn
11 years agocatheresults
11 years agoSameiHuda
11 years agoMatthewLake13
11 years agoideas4thefuture
11 years agoDebiecJacek
11 years agosbuehler
11 years agoMavenIntlUK
11 years agoAbigail Orléans Lindsay
11 years agoHughAsher
11 years agoSubMisuseGcu
11 years agoNasmAfrique
11 years agocarotomes
11 years agoideas4thefuture
11 years agocathbeany
11 years agoUCLPsychiatry
11 years agoESPsychotherapy
11 years agoevolvingfamily
11 years agocherylholt
11 years agowilliamspsych
11 years agoKathryn Self
11 years agoSue Ord
11 years agolittlemissevec
11 years agoAlexC93
11 years agoVoiceofT_Reason
11 years agokickivirby
11 years agoideas4thefuture
11 years agoDerekK29917053
11 years agoPoliceMHFailure
11 years agoCherrilLawless
11 years agotomneumark
11 years agoCllrMc
11 years agorosieed25
11 years agoJdrs1090
11 years agoarlo_lefty
11 years agofluxopensamento
11 years agofishisoff
11 years agoRosemary Callahan
11 years agoRtoRorg
11 years agolrv451
11 years agomiseliz
11 years agotamiyabjohnston
11 years agomindliveproject
11 years agoAnna_K_Taylor
11 years agoIMHASociety
11 years agopaulamreid
11 years agoPsychMarwaha
11 years agoCUSERgroup
11 years agohelenlp
11 years agoDramaLlama85
11 years agoDrVishalBhavsar
11 years agosoniajohnson
11 years agoDrVishalBhavsar
11 years agoGCBarnwell
11 years agoclivestone22
11 years agoRuftyRoo
11 years agoLisalives247
11 years agoLisaMBrophy
11 years agolypftlib
11 years agotiredlegs
11 years agocityalan
11 years agoBetty_Highton
11 years agobrixtonbarb
11 years agoMental_Elf
11 years agoThe Mental Elf
11 years agoStavrosOrfanos
11 years agowellred5
11 years agoStavrosOrfanos
11 years agosoniajohnson
11 years agoJune Dunnett
11 years agoLauren Davis
11 years agoChat_qui_rit
11 years agoPWoodfall
11 years agoMental_Elf
11 years agoSCIE_sco
11 years agoSomaPsy_Nant
11 years agoJasonChunLee
11 years agoUoGMHNS
11 years agoMarieLouiseLu
11 years agocecilia_brando
11 years agoSam Wyatt
11 years agoRachel Gilberthorpe
11 years agowolhealthyminds
11 years agoIanCummins9
11 years agoTherapyCompany
11 years agoStephenWood8
11 years agoMegEliz_
11 years agoBABCP
11 years agoayse_d
11 years agoJohnBaker_Leeds
11 years agoGreg_Reardon
11 years agokatekarban
11 years agothexaurus
11 years agoNafeezAhmed
11 years agoDrMatthewBrown
11 years agobilginhulya
11 years agoMentalhealthMSc
11 years agosci_pract
11 years agoian_hamilton_
11 years agoNicola Davies
11 years agoSmithson71
11 years agoUCLPsychiatry
11 years agomissdml
11 years agosoniajohnson
11 years agoNick_S_Fitz
11 years agoLiaisonLawson
11 years agoArianePSY
11 years agoMissTillyflop
11 years agodavid3012
11 years agomel_lean
11 years agoOTBeth131
11 years agoaghoury79
11 years agoian_hamilton_
11 years agoCygnetNurses
11 years agoSocialCareElf
11 years agoSchrebersSister
11 years ago121Therapy
11 years ago