Mental Illness and Risk of Violent Crimes

Introduction 

Mental illness and violence are critical topics that have continued to raise interest and extensive research in the forensic and mental health fields. The connections between the two terms have raised constant debates throughout psychiatry, criminology, psychology, and even in legal frameworks such as courtrooms. Thus, the topics cut across multiple fields including criminal justice, correctional systems, the public, and mental health profession. The wide array of debates has elicited extensive research on why the people who are mentally ill commit crimes. This raises issues that concern the identification of such mental illness, what they entail, and how to approach the matter. There have been discussions about the need for, the nature of and care of mentally ill individuals. Most of the time, the debates are always based on the notion that many of the people with mental illness are more predisposed to exhibit violent and criminal behaviors due to their mental states as compared to the ones without these conditions. These acts can be caused to the public, close friends, close relatives, or themselves. 

The connection between the acts of violence and crime and mental illness cannot be exaggerated. A lot of research has indicated that violence is related to the state of being impaired in the thoughts and emotions (psychosis), and losing touch with the external reality. With this in mind, the people who have mental illness are also in this category and thus the link should be observed. Drugs and substance abuse has also been linked to acts of violence as it is said that it accelerates the condition for people with mental illness. This leaves the gap to the questions; what is the link between mental illness and crime? Is it possible to join the dots between the mental disorders and violent behavior? As such, this paper tries to relate these two widely debated topics and providing an expansion on the already existing literature. This research will provide the definition of mental illness with relation to various medical and legal frameworks and demystify some theories that exist in the public domain. In addition, it will define criminality differently and try to draw some links to each other. 

Methodology 

Online search for databases was conducted to retrieve the scholarly published materials and professional articles. The search was conducted using the key words such as “mental illness,” “mental disorders and crime,” and “violence from mental disorders.” The results obtained were narrowed down in terms of relevance and currency. Given the fact that this topic has been extensively researched in the past, it was important to select the materials that give the perspective of the previous studies. Thus, the selection was done on the papers that were published from the year 2000 onwards. The selection of such papers was based on quantitative primary studies only. A maximum of twenty resources were retrieved and in this, ten were used to compile the research. A review of literature then ensued to condense the information to form the final draft. 

Literature Review 

Like psychopathology, mental illness and mental disorder are terms that have continued to bring much debate on their use and definition. Even though such deliberations exist, some diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases, Injuries and Causes of Death (ICD-10) have produced attempts to define the mental disorder and what constitutes such by forming classification rationales. The reason behind creating such initiatives is to maintain a uniform and standard language of communication. They attempt to create an accessible taxonomy on mental illness which can be used interchangeably between healthcare professionals and the fields. The classifications have support that are substantially empirical, and have theoretical cogency thus can be utilized in a clinical setting. 

The DSM manual is considered as leading fundamental doctrine of assessment of psychological conditions and treatment, despite being a subject of criticism. The manual itself indicates that the psychopathological disorders are not adequate in definition and that each one depends on the specific situation. There was no concrete definition of the term “mental disorder” till the third edition, with the current version of the manual trying to illustrate the approach it takes in the description of mental disorders and their constitutions. It does this by fruitfully collecting the many traditional concepts that included harmful dysfunction, social deviance, distress, dysfunctional behavior, and statistical deviance. With this regard, DSM-IV gives the definition of mental disorder as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom…It must currently be considered a manifestation of a behavioral, psychological or biological dysfunction in the individual (APA, 2000).” 

In this definition by the DSM, there is a clear perception of existence of two principles that determine the manifestation of mental disorders and the diagnosis. First, there must be an internally caused syndrome, be it biological or psychological, which results to the manifestation of negative consequences for the behavioral functioning of the individual. The cognizance of the knowledge that surround the syndrome and the consequences it has will be helpful to the people in the field with making the correct diagnosis of mental disorder and providing an appropriate treatment. Inasmuch as the psychological and behavioral symptoms are the primary diagnostic criteria, there is need for evaluation of other critical information concerning the individual that may be helpful in bringing more meaning to the explanation of mental illness. These evaluations may include models of psychopathology which are concerned with the biological and psychosocial effects on abnormal behavior which may lead to a more precise diagnosis of mental disorder (Bartol & Bartol, 2014). Despite each model trying to explain the specific causes and consequences of mental disorder from a definite point of view, of benefit will be the existence of an integrative approach that include various or all of the available models as it would better help in the understanding of the potential causes of mental illness and the interventions. However, even before the diagnosis is made, there should be an attempt to understand the totality of the person in concern. 

Despite the DSM being a clear-cut manual, its classification and definition are multi-axial which offer the possibility of an individual to be diagnosed on various grounds while considering a huge volume of information concerning the patient. The axes are categorized into Axis I (major mental illness), Axis II (personality disorders and long term psychological impedance and developmental conditions), Axis III (general medical conditions that impair the functioning psychologically), Axis IV (environmental and psychological problems which can impair the mental state), and Axis V (present level of functioning of a patient at the time of diagnosis (APA, 2000)). When all the factors of the conditions that the individual undergoes are carefully evaluated, then a thorough and more accurate diagnosis of the patient can be achieved. There are instances where some other mental conditions are ousted and are not considered as such based on the amendment of the law. Such disorders include homosexuality which is affected by the changes in the society and the laws. With is effect, there are some other abnormalities, which are not as of present considered mental disorders, that may be included in the DSM manual in the future based on the same reason as the exclusion of other conditions. This brings an impression that mental illness is more of a societal construct than scientific condition. 

The twist that mental illness is a social construction brings us to the definition of crime. Similarly, crime is a legal concept that can be both politically and socially influenced and set up by institutions or people that rule. They decide what may or may not be considered as crime. Despite crime being dependent on the type of culture in question, there is a universal approach to it in that it involves a mens rea (guilty mind) and actus reus (guilty act). In other words, it involves the intentional action directed towards a target that is from the same group. In this effect, the crimes can be classified as minor (less serious) or major (more serious) acts of criminality. However, the institutions characterize an act of juvenile delinquency such as jaywalking or vandalism as serious as an act of murder or physical assault. But, the area in criminology that raises the most of concern on the cause and effects are the more serious crimes that involve violence and include homicides, property crime, and assault. Just like there are also theories trying to explain the causes of mental illness, there are also ones that try to explain the potential causes that make people commit such acts of violent crimes. This has been the basis of the famous debates that has made the causes be considered as social learning, psychoanalytic, personal, and biological theories (Bartol & Bartol, 2014). 

Extensive research has inquired into a potential link between the mental disorders and the acts of violence. As a result, they have documented possible findings which indicate a special relationship. But, this should not be a bottom-line conclusion that all mentally ill patients are violent or that all offenders are mentally ill. In fact, only a small number of the psychiatric out-patients have been charged with serious offences. It is difficult to examine the close relationship between criminality and psychiatry due to the fact that many advancing factors can have an effect on the determination of this relationship. On that note, this paper will focus on the occurrence of a major mental disorder which is listed in the DSM-IV specifically from Axis I and another personality disorder from the same manual from Axis II. This is in line with the assessment of the special relationship that has been attributed to the specific diseases and the rate of crime of acts like drug, property, and homicide offences. 

A common disease from the Axis I is schizophrenia and according to DSM-IV is considered a serious psychotic disorder as it is accompanied by symptoms such as difficulty in communication and language, hallucinations, and delusions (APA, 2000). To that effect, an individual who has schizophrenia has difficulties in connecting to reality and experiences symptoms that exhibit behavior like withdrawal and psychosis that has an effect on his or her overall functioning in the community and even in caring for oneself (Silverstein et al., 2015). For instance, the delusional thoughts of paranoia that a schizophrenia patient experiences can make him or her to act aggressively as a response to others. This reaction can be as a result of the feeling of being confronted or threatened. This phenomenon is a manifestation of a reactivation of delusional concept or an abrupt mental stimulation that makes the individual feel that he or she needs to react for survival (Hodgins & Müller-Isberner, 2014). But, when criminal act is displayed as the consequence, precursors such as environmental and social causes, which may play important role in the response, need to be assessed. 

The reaction that the patients of schizophrenia and the risk of involvement in violence they display has been the reason for the concentration of research on these patients which try to explain the relationship between this mental disorder and violence (Silverstein et al., 2015). While some researchers, institutions, and practitioners try to oppose the relationship, studies have continued to link these two topics and providing evidence on the relationship between schizophrenia and violence in the assessment of homicides. However, each case under assessment needs to be discretely analyzed as the consequences for the link will be variable depending on the form of criminality exhibited and the influence of alcohol and substance abuse at the time of the scene. The relationship between schizophrenia as the main mental disorder in the perpetration of criminal acts has been backed by data from remand and prison populations as well as mental care facilities, which house a large number of criminals with mental illness (Hodgins & Müller-Isberner, 2014). Studies have indicated higher rates of people who are arrested and are mentally ill, as well as those who have been imprisoned, as compared to the general public. It is imperative to note that these data also depend on the identification of a specific disorder as being related to criminality (Silverstein et al., 2015). Most of these studies still point out those primary mental disorders such as schizophrenia are increasing the risk of aggressive and violent reactions and behavior. 

For instance, in a study by John M. W. Bradford (2008), there was an evidence of comorbidity among mentally ill patients. In the study, the researcher tried to analyze the role of psychological conditions in assessing violence in individuals with mental disorders (Metzl & MacLeish, 2015). It was evident that there was a common factor of comorbidity between the association of violence with mental disorders and recommended that improved risk assessment and treatment intervention can help in reducing the rates of violence. In a separate research conducted by Modestin and Wuermle (2005) there was an assessment of 282 patients with schizophrenia and 261 others with other affective disorders. In the male-only study, the researchers found out that the criminal record of patients with schizophrenia was accounting for 34 percent and that of the ones with affective disorder was at 42 percent. In the same study, more than half the total number of patients had co-occurring drug use. The research concluded that the people with schizophrenia and lacking a comorbid drug are at an increased risk of engaging in criminal activity that involves violence than those with affective disorders. The latter had a greater risk of committing property offenses. Thus, the research suggests that the link between violence, mental illness and psychopathology is minute. 

Schizophrenia patients are not only susceptible to committing criminal offenses like homicide (Hodgins & Müller-Isberner, 2014). Despite the commission of crimes which may be exhibited at different stages of the mental disorder, and defined by the commission under the influence of drugs or abstinence, the reaction from these patients can also manifest in other types of crime. It is also imperative to note that patients at different stages of the mental illness can produce varying results as far as the assessment of criminal activities are concerned. The ones with chronic schizophrenia have the likelihood of committing only traffic offences, while those with lower forms of schizophrenic symptoms commit crimes against drug laws or property. The highest perpetrators are those who suffer from acute schizophrenia as they commit the most violent crimes. In comparison to the general public, the research revealed that the people with schizophrenia are five times more susceptible to commit the violent crimes (Bartol & Bartol, 2014). Of these they were two and a half times more likely to commit property crimes and three times more to commit drug offenses. In this case, the variation in the commission of crimes in different levels of schizophrenia is an indication that there is a link between the mental disorder and the different types of crimes. 

Discussion 

Violence and the Mentally Ill 

Over the past decades, a lot of questions have arisen on the connection between mental illness and perpetration of crime in the daily legal practice. To that effect however, there has been progressive evidence on the link between mental disorders and the acts of violence in daily clinical practice. This has seen a rising willingness on the part of many psychiatric professionals to foresee and manage violent behavior despite initial assertions that refuted the capability of mental health professionals to predict violence (Bartol & Bartol, 2014). With the rise in the actuarial risk assessment instruments, evaluations of violence have become increasingly promoted as fundamental mental health skills. These skills are expectations of mental health professionals; they form the key aspects clinical management that is socially responsible; and are prized in correctional settings and court of law. 

Many mental health professionals, particularly those practicing in acute or emergency care settings, report that the individuals who are mentally ill directly exhibit violent behavior. For instance, in Canada where the population experience less episodes of violence as compared to other countries, most psychiatrists are engaged in the treatment and management of violent behavior. Out of the many, about 50 percent have reported direct assault from a patient at least once. But, it should be noted that the experiences that are exhibited in the clinical settings do not necessarily represent the behavior of the majority of mentally ill individuals. The practice of psychiatry has been experiencing social changes that have led to the extensive adoption of the legislation that lays the standard for dangerousness on civil commitment (Bartol & Bartol, 2014). Thus, it only gives the chance of individuals with the highest risk of violence to receive treatment in acute care settings. 

Therefore, there are limitations to how the violent and disruptive behavior is clinically explained. The field focuses on the attributes of mental disorders and the mentally ill while leaving out the contextual and social elements that act together to contribute to violence in clinical settings. There is evidence that even in the treatment units that are identical in clinical mix and acuity, the rates of aggression across the settings are varying at great measures. Thus, this is an indication that mental illness is not a sufficient cause for the perpetration of violence (Stuart, 2003). In bid to examine the precursors of aggressive behavior in the treatment in inpatient units, studies have the majority of the occurrences have critical social or structural precursors such as poorly structured transition of activities, lack of activities, ward restrictions, overcrowding, lack of clinical leadership, and ward atmosphere. 

It is not uncommon for the public to get accustomed to the experience of violence among the mentally ill individuals (Jorm & Reavley, 2014). However, these cases are most of the time remote, through the depiction of the movies characters that are portrayed as crazed killers or in real life drama acts played out with a lot of frequency on the daily news. In fact, there is a notion that the global reach of news makes sure that the viewers have a steady supply of real-life violence that is mostly linked to mental disorders. It is evident that the public are afraid of the act of violence that is unpredictable, senseless, and random and they associate such occurrences with mental illness (Shultz et al., 2014). This makes the public more assured to when they hear that someone was shot to death in a robbery with violence, than shot to death by a mentally ill individual. When cases are reported about the involvement of a mentally ill individual, the public always goes into a panic and starts showing desires to distance itself socially from the mentally ill thus creating chances of victimization. After each publicized attack, the distance grows remarkably and never returns to the original value (Jorm & Reavley, 2014). Furthermore, the cases are always corresponding to the increase in the perceptions of the public that those who are mentally ill are dangerous and unpredictable. 

Media is responsible for the reinforcement of the notion that people who are mentally ill are violent and dangerous. It is this narrative that makes the public have the theory that the high prevalence rates of mentally ill individuals in correctional facilities and prisons is because individual with mental illness are violent (Jorm & Reavley, 2014).. The media has been a forerunner in advancing this perception with coverage of mass shootings over the past years. An instance is in 2012 when Adam Lanza shot twenty kids and six adults in Sunday Hook Elementary School in Newton, Connecticut before committing suicide. Reports indicated that he had diagnosis of an autism spectrum disorder. The same year but a little earlier, James Holmes burst into a full movie theater before opening fire killing twelve people in Aurora, Colorado hence killing twelve people and left additional seventy wounded (Rosen & Teasdale, 2016). Upon going to trial, he pled not guilty on insanity grounds. The media thus focused on his health rather than the consequences of what he did and thus portraying the people who are mentally ill as absolutely violent. 

Jared Loughner killed six people in Tucson, Arizona in 2011 and wounded a dozen others. One casualty was the US representative Gabrielle Giffords. The media coverage on their side focused on the mental health history of the perpetrator and thus attributed these killings to the episodes of psychosis. Another scenario few years earlier involved the killing of thirty-three people at Virginia Tech University, in Blacksburg, Virginia, with Seung-Hui Cho being the perpetrator. This was before he shot and killed himself in the same spot. The media coverage focused on his psychosis history and made headlines which were such as “Help the Ill before They Kill.” This indicates that any mentally ill person out there has a higher chance of committing such atrocities and thus making the public panic about them. The headlines of violence that involve people with serious mental illness make the unpredictable and irrational acts to spark public fear (Corner & Gill, 2015). Consequently, the pervasive belief that mental illness leads to unpredictable and irrational violence becomes advanced. 

But, these isolated cases of extreme aggression only accounts for a small percentage of criminal activity that the people with mental disorders engage in. Thus, it is imperative to demystify the notion that most people with mental illness are violent. This is in line with extensive studies that have shown that mentally ill individuals are less likely to engage in acts of violence as compared to their counterparts who do not have mental disorders. The criminal activities that the people with mental illness engage in are thus survival crimes such as urinating in public or reactive crimes which involve response to physical victimization. 

In democracies such as the United States, the opinion of the public is complicated. The population judges the acts of violence differently based on who does the diagnosis, and the rankings often correspond to the existing findings of studies (Bartol & Bartol, 2014). However the directions that the researches take, the public always view the individual under the dependence of drugs as those who are more likely to commit crimes, followed by those having schizophrenia and other mental conditions. 

The perceptions of the public concerning the connection between mental disorders and crime are crucial to the identification and management of stigma and discrimination that sees people more likely to tolerate coerced treatments and forced actions against individuals having these conditions when violence is at the core of the issue (Bartol & Bartol, 2014). Also, the notion that the individuals are more likely to commit acts of violence may be responsible for the justification of the bullying and the victimization that the mentally ill patients are exposed to. There is an increasing rate of victimization towards the mentally ill which most of the time goes unnoticed in clinical setting and hence become undocumented in the medical records. 

Symptoms versus Traits 

It is extremely difficult to single out and distinguish a symptom of mental disorder and the general risk factors of violence when the psychopathological condition is extended beyond psychosis (Bartol & Bartol, 2014). For instance, It is evident that anger is strongly related to symptoms of psychosis (delusions and hallucinations), post-traumatic stress disorder, mood disorders (irritability and anger attacks), and personality disorders (including emotional stability). On the other hand, anger is also an important factor in the primary human emotion that is also a strong precursor for the criminal acts of violence which can be experienced in both the psychiatric offenders and general perpetrators. 

Some studies have indicated that anger is a base indicator of predicted violence, as contrasted with the other symptoms that are related to mental illness like delusion and hallucinations. However, while tackling anger as a symptom of mental condition that is a factor of violence can jeopardize the human emotion by making it be viewed as an indicator of a serious mental disorder. 

Another dilemma is seen in the characterization of impulsivity and distinguishing it as far as the perpetration of violence is concerned. The condition may be related to specific symptoms of bipolar disorder which may include the ease of being distracted and the susceptibility to be involved in excessive pleasurable behaviors which can lead to a painful outcome. Thus, it is not uncommon to associate the symptom of impulsivity to the people suffering from bipolar disorder as compared to the general population. In contrast, impulsivity is a factor that is commonly used as one of the diagnostic criteria for antisocial personality disorder. In that effect, it has been singled out as one of the most prominent precursors of violent acts among both adults and juvenile offenders (Bartol & Bartol, 2014). Thus, it is difficult to explicitly single out when impulsivity is a normative personality trait or a symptom of an underlying serious mental disorder. 

Risk of Violence from Mentally Ill 

All the research linked with the topics of violence and mental illness show some conclusive results. The scientists are not interested in isolated cases of crime that is committed among the mentally ill patients but instead focus on the possibility of them committing the acts of violence with higher frequency or cruelty as compared to those without the mental disorders. This bears the questions to whether the individuals who are mentally ill can be at an advanced risk of violence, which makes the core of the scientific debates. 

Despite the existence of evidence that links the mental disorders to crimes, it is difficult to draw definitive conclusions as it is equally possible to get current literature which shows evidence of mentally ill not being violent, being as violent, or being more violent than their counterparts who are not mentally ill. Over the past three decades, the predominant notion was that the individuals who are mentally ill were less likely to be violent. As a result, the assessment of violent criminal activities in the mentally ill patients was done just the same way by looking at the criminogenic factors that would be associated in any part of the population. These included factors such as age, gender, ethnicity, poverty, or indulgence in drugs (Rosen & Teasdale, 2016). Thus, the occurrence of violence in high rates in the mentally ill population was as a result of the elevation of these precursors but psychopathology was not considered as a standalone factor that would lead to the commission of violence. When the precursors were controlled statistically, the rates of cases of criminality cases equalized. But, even though the primary risk factors for crime and violence still stays to be lower socio-economic class, single, male, or young, some current literature has given reports on the modest association between the mentally ill and the commission of violence, even after the control of these components. 

But, the significant methodological challenges that the researchers face in this field, the connection between the two remains a mirage. For instance, it is difficult to measure violence directly. This hurdle has made the scholars rely on uncorroborated self-compiled reports or official documentation. This is the reason that lies in the dramatic variance that exists among sources that demonstrate prevalence of violence. In retrospect, most of the studies have not been a representative of all the mentally ill patients, but only of the individuals who have a higher risk of becoming violent and dangerous (Stuart, 2003). For instance, they only represent the individuals who are arrested and those who are hospitalized. These studies have not single out the history of violence in individuals, which is an important precursor of future engagement in violence; determined sequence of cases; or controlled for co-morbidity with substance abuse. In the long run, any causal argument that can be made is greatly weakened. 

However, there are some scholars and researchers who are trying to solve the problems that arise in the assessment of the link. One of the works that are recently compiled includes the MacArthur Violence Risk Assessment Study which has made determined effort to address the gaps (Monahan et al., 2001). It is considered as one of the most sophisticated attempts that strive to sort out the complicated relationships between mental illness and violence. The large collection of follow up data in the study (N=1,136) on the cohort subjects makes it possible to shed light and clarify the temporal sequencing of important cases. This study has minimized the information bias that has existed in other research by using multiple measures of violence, including self-report from patients (Monahan et al., 2001). It also employed the innovative use of same-neighbor method to compare subjects and thus eliminating the confusion from the generalized environmental factors such as socio-demographic or economic precursors that may have caused exaggeration in the differences in the previous studies. 

In the research the likelihood of individuals who had a major mental illness but which were not comorbid with any drug use was indistinguishable from their counterparts who were non-substance abusing neighborhood. When there was a concurrent drug use, the prevalence of violence doubled. The individuals with major depression had the highest occurrence of violence in the course of one year accounting for 28.5 percent as compared to bipolar disorder which accounted for 22.0 percent and those with schizophrenia recording the lowest prevalence at 14.8 percent (Monahan et al., 2001). According to the research, delusional cases were not linked to violence of any kind. This is true even for ‘threat control override’ delusion did not associate with violence. This is a form of delusion that makes one think that harm is on their way or that someone is trying to control their mind and thus the expectation is that they have to react violently. In the previous studies that cut across sections in the United States and Israel, threat-control override delusions were heavily linked to increased risk of violence due to retaliation. 

Risk of the Public 

Of importance is the fact that serious mental illness and serious violence are rare occasions. Subsequently, it is challenging to conclusively judge the practical importance of the results from studies that may indicate elevated prevalence of violence among samples of individuals who are mentally ill. These findings tell us little about the risk that the public is exposed to due to these cases. It gives a gloomy picture of how the public feels about the elevating levels of the prevalence, despite the unpredictable and erratic explosion of violence that the media covers causing outrage and fear to the people (Rosen & Teasdale, 2016). Thus, there is a gap that exists between the mentally ill patients and the public, which scholars and scientists try to overlook. 

One means of tackling this issue is to form questions that try to seek the targets of this violence perpetrated by the mentally ill individuals: Are the targets members of the public or members of close relationship? Several studies have indicated that the violent episodes among the individuals with mental disorders are ignited by the situations of their social life, and also be the nature and quality of those close to them in their social interactions. For instance, in the MacArthur Violence Risk Assessment Study, the most probable target of the violent cases from the subjects included the family members or friends and this accounted for 87 percent of the episodes (Monahan et al., 2001). Most of the cases saw the violence perpetrated at home or closer to the targets. Patients who were discharged had a lesser likelihood of attacking or targeting total strangers and this accounted for 10.7 percent as compared to the ones in the community who were at 22.2 percent. In a similar fashion, another study that tracked 169 people with serious mental disorder over thirty months found out that the violence was most likely to erupt in the family setting. This was particularly during the time when relationships were described by financial dependence, hostility, and mutual threat. This was also the case when there was an infrequent use of outpatient mental health services (Stuart, 2003). The study also found out that in over the 3,000 people from the social network, only 1.5 percent ever experienced the violent acts or threats from mentally ill individuals. 

Another important question that can help in the assessment of the relationship is to what extent the mentally ill individuals compare with the overall prevalence of violence in the community. Some studies in the United States have indicated the attributable risks for self-reported crimes as reported in the population. The term ‘attributable risk’ refers to the overall impact a precursor has on the level of aggression or violence in the public. The study found out that the individuals with major mental disorder accounted for 4.3 percent population attributable risks (Steadman et al., 2015). In other words, the results show that if the serious mental disorder would be treated or eliminated, violence in the community would reduce by less than five percent. Of importance is the percentage of population attributable risks for those who had drug use comorbidity and the ones with drug abuse disorder only. For the isolated substance users, the attributable risks were as high as 34 percent. For those with comorbidity of mental illness and drug use it was five percent. In retrospect, the results indicate that when the mental disorders and comorbid disorders are eliminated from the community, violence would be reduced by only 10 percent (Steadman et al., 2015). On the other hand, eliminating substance abuse disorders would see violence in the community reducing by over 30 percent. 

By employing similar approach, one can ask the proportion of violent crimes that involve a police arrest and detention that could be characterized by the involvement of mental illness. In a Canadian study to identify this phenomenon, a survey was conducted on 1,151 newly detained criminal offenders. This study represented all the people jailed in a geographically defined region. Out of the total number, it was found that three percent of the violent crimes that this sample committed were traceable to the individuals with major mental illness like depression or schizophrenia (Stuart, 2003). On that same note, it was noted that crimes that were attributable to primary substance use disorders accounted for seven percent. On the effect that major mental illness and substance abuse disorder could be withdrawn from the sample, the proportion drop in violence would be about ten percent. 

Conclusions 

This comprehensive research comes to several conclusions. First, mental illness cannot act as a standalone precursor, or as a sufficient cause of crime involving aggression. The key factors in the commission of violence still remain to be the long known ones which include being from a lower socio-economic status, male, and young. Secondly, the public has an exaggerated view on the people with mental disorders and the strength of the link between them and violence. They have their personal risks from people who are severely mentally ill. This is due to the coverage of the media which focus on the mental health of the offenders of mass killings. However, it is clear that there is more likelihood that those who are mentally ill will be victims of physical stigmatization. The other conclusion is that drug and substance abuse play a significant role in the determination or perpetration of crime. This is true whether it exists in concurrent with mental illness or singly. The individuals who have substance abuse disorders contribute significantly to violence in the community, and this accounts for as much as 30 percent of self-reported acts of violence. They also account for seventy percent of every crime involving violence among offenders who are mentally ill. Lastly, there is too much concentration of research on the individual with the mental disorder, instead of the nature of the social factors that could have led to the violence. Therefore, little is known than what there is to be known on the nature of the relationships and the contextual precursors of violence. This leads to much less than what should be done on the crucial intervention. However, the current studies recommend and support the early recognition and treatment of substance abuse issues, and more attention to be provided to the diagnosis and treatment of concurrent substance use disorders among the patients who are mentally ill as this would be a potential strategy in the prevention of violence. 

Recommendations 

The future of studies that involve mental illness and violence is vast and therefore should take some direction which the current studies have ignored. One recommendation the researchers should extend focus on the contextual and social factors that act together to contribute to violence in clinical settings. Secondly, the scientists should be interested in every isolated case of crime that is committed among the mentally ill patients instead of relying on their susceptibility to commit such crimes. 

References 

American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington, DC: American Psychiatric Association. 

Bartol, A. M., & Bartol, C. R. (2014). Criminal behavior: A psychological approach. Boston: Pearson, c2014. xxiii, 644 pages: illustrations; 24 cm.. 

Bradford, J. M. (2008). Violence and mental disorders. 

Corner, E., & Gill, P. (2015). A false dichotomy? Mental illness and lone-actor terrorism. Law and human behavior, 39(1), 23. 

Hodgins, S., & Müller-Isberner, R. (2014). Schizophrenia and violence. 

Jorm, A. F., & Reavley, N. J. (2014). Public belief that mentally ill people are violent: Is the USA exporting stigma to the rest of the world?. Australian & New Zealand Journal of Psychiatry, 48(3), 213-215. 

Metzl, J. M., & MacLeish, K. T. (2015). Mental illness, mass shootings, and the politics of American firearms. American journal of public health, 105(2), 240-249. 

Modestin, J., & Wuermle, O. (2005). Criminality in men with major mental disorder with and without comorbid substance abuse. Psychiatry and clinical neurosciences, 59(1), 25-29. 

Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., ... & Banks, S. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. Oxford University Press. 

Rosen, M. J., & Teasdale, B. (2016). Mental Illness and Crime. The Encyclopedia of Crime and Punishment. 

Shultz, J. M., Thoresen, S., Flynn, B. W., Muschert, G. W., Shaw, J. A., Espinel, Z., ... & Cohen, A. M. (2014). Multiple vantage points on the mental health effects of mass shootings. Current psychiatry reports, 16(9), 469. 

Silverstein, S. M., Del Pozzo, J., Roché, M., Boyle, D., & Miskimen, T. (2015). Schizophrenia and violence: realities and recommendations. Crime psychology review, 1(1), 21-42. 

Steadman, H. J., Monahan, J., Pinals, D. A., Vesselinov, R., & Robbins, P. C. (2015). Gun violence and victimization of strangers by persons with a mental illness: data from the MacArthur Violence Risk Assessment Study. Psychiatric services, 66(11), 1238-1241. 

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry, 2(2), 121.