Who is the victim ? Mentally ill individual

In North Carolina, 331 individuals with severe psychiatric disorders (schizophrenia, schizoaffective disorder, affective disorders with psychotic features) were questioned about victimization in the 4-month period immediately preceding their psychiatric hospitalization. All 331 individuals had been referred for outpatient commitment, strongly suggesting that they were noncompliant with their medications.  Of the 331 individuals, 27 (8.2 percent) had been the victim of a violent crime (assault, rape, or mugging) within the previous 4 months, a rate 2.7 times higher than the annual rate of violent criminal victimization in the United States. 

More than one fourth of individuals with severe mental illness (SMI) were victims of violent crime in the past years starting from 2004 where the research started, eleven times the rate in the general population, according to a study in the 2005  August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Prior studies suggest that individuals with mental disorders who live in the community are a vulnerable population at high risk of becoming victims of crime, according to background information in the article. Symptoms associated with severe mental illness, such as disorganized thought processes, impulsivity and poor planning and problem solving may compromise one’s ability to perceive risks and protect oneself, the authors suggest. Other factors correlated with victimization, including substance abuse, conflicted social relationships, poverty and homelessness, are also common among persons with severe mental illness.

Linda A. Teplin, Ph.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues administered the National Crime Victimization Survey (NCVS) to 936 randomly selected patients from 16 outpatient, day or residential mental health agencies in Chicago, comparing the results to data from the 32,449 participants in the annual NCVS conducted by the Bureau of the Census for the Bureau of Justice Statistics. The surveys of the individuals with severe mental illness were conducted by clinical research interviewers with master’s level training.

“Over one quarter of the SMI sample had been victims of a violent crime (attempted or completed) in the past year, 11.8 times higher than the NCVS rates; nearly 17 percent of the SMI sample had been victims of completed violence,” the authors report. “More that 21 percent of persons with SMI had been victims of personal theft (theft of an item from one’s person), more that 140 times higher than the NCVS rates. … Nearly 28 percent of persons with SMI had been victims of property crimes, approximately four times higher than the NCVS rates.”

“In the general population, crime victimization can cause anxiety, depression, substance use disorders, and post-traumatic stress disorder,” the authors write. “Among persons with mental disorders, victimization can exacerbate existing disorders, increase the likelihood of service use and hospitalization, and substantially diminish quality of life. Moreover, victimization increases the likelihood of revictimization and is associated with perpetration of violence among persons with SMI, just as in the general population.”

“Among persons with SMI, violent victimization is far more prevalent (more that 25 percent within one year in this study) than perpetration of violence (4 percent – 13 percent),” the authors write. “Crime victimization among persons with SMI must be addressed the same way as other health disparities are addressed: by using all available tools and resources to reduce the risks and consequences of this public health problem.”