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Hosp Community Psychiatry. 1994 Jul;45(7):653-62.

Violent behavior by individuals with serious mental illness.

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National Institute of Mental Health Neuroscience Center at St. Elizabeths Hospital, Washington, DC 20032.



The perceived association between violent behavior and serious mental illness was explored to determine the validity of claims by mental health advocates that individuals with serious mental illness are no more dangerous than members of the general population.


The author reviewed recent studies and media accounts of violent behavior by individuals with serious mental illness, with emphasis given to the most recent studies.


Although the vast majority of individuals with serious mental illness are not more dangerous than members of the general population, recent findings suggest the existence of a subgroup that is more dangerous. A history of violent behavior, noncompliance with medications, and substance abuse are important predictors of violent behavior in this subgroup. The findings imply that the criteria for involuntary hospitalization, involuntary medication, outpatient commitment, the monitoring of medication compliance, and other mandated follow-up procedures may need to be revised. The existence of a subgroup of seriously mentally ill patients who exhibit violent behavior undermines efforts by mental health advocates to reduce the stigma of mental illness by denying an association with violence. Until the problem of violence by this subgroup is addressed, it will be difficult to substantially decrease the stigma associated with serious mental illness.

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