Misperceptions about the relationship between mental health, mental illnesses and violence contribute significantly to stigma, discrimination and social exclusion. Studies indicate that people living with mental health conditions are no more likely to engage in violent behaviour than the general population (September, 2011)

People living with mental health conditions may experience stigma, discrimination and social exclusion that significantly impacts on their lives. Misperceptions about the relationship between mental health, mental illnesses and violence contribute significantly to these experiences. Studies have shown that people living with mental health conditions are no more likely to engage in violent behaviour than the general population. However, public perceptions, often influenced by the media, are contributing to attitudes that have a significant impact on the lives of people with mental illnesses.

What We Know

Estimating the rate of violent behaviour by people with mental illnesses is complex, and a definitive causal relationship between violence and mental illnesses has not been established. There are challenges due to definitions, data gaps and technical issues related to the reliability, consistency and generalizability of available data.

People with mental health conditions experience stigma, discrimination and social exclusion that significantly impacts on their lives, including fears that they may be violent.

People with serious mental illnesses are more likely to be victims of violence themselves, than the general population.

Freedom from violence and discrimination promotes positive mental health and well-being.

Media reporting and portrayals contribute to public misperceptions about the relationship between violence and people with mental illnesses.

Considering language

The fear that people with mental health conditions may be dangerous or violent is at the core of the stigma, discrimination and social exclusion experienced by individuals with mental health conditions. 1, 2, 3 Research on public perceptions and attitudes about mental health have identified stereotypes that people with a mental illness pose a threat to public safety.4,5 Indeed, a 2008 study found that one in four Canadians admitted they would be fearful to be around someone with a serious mental illness.6 As detailed below, existing research indicates that these fears are misplaced. So what is behind these fears?

Language plays a key role in how we think, talk and respond to this complex issue and can contribute to misperceptions about violence and mental health. There are many forms of violence, including physical acts, such as physical or sexual abuse, and non-physical acts, such as emotional abuse, harassment or intimidation. Violence can be directed against others or against oneself.

The term “mental illness” is misleading because it suggests that all mental health conditions or illnesses are the same, or have similar characteristics. In reality, there is no single mental illness, but a range of mental health conditions with different symptoms and experiences. Oversimplifying discussions about mental illnesses can incorrectly infer that all individuals who are living with mental health conditions are impacted in the same way, or that all individuals share the same behaviours. In many cases, symptoms of acute mental illnesses are episodic, surrounded by periods of recovery or wellness.7 Thus, a person can experience mental well-being in spite of a diagnosis of a mental illness.

Media influence on public attitudes

Many studies have found that media and the entertainment industry play a key role in shaping public opinions about mental health and illness. People with mental health conditions are often depicted as dangerous, violent and unpredictable.8,9 News stories that sensationalize violent acts by a person with a mental illness are typically featured as headline news; the comparatively small number of articles that feature stories of recovery or positive news about individuals with a mental illness are often opinion pieces or are framed in the lifestyle or health section.10,11 Films and television shows often portray individuals with mental illnesses as hypersexual, dangerous and/or violent.12 As Dr. Heather Stuart, a leading Canadian researcher in the area of mental health and stigma, notes, the violent depictions are simply more memorable for the viewing public.13

Entertainment frequently features negative images and stereotypes about mental illnesses, and these portrayals have been strongly linked to the development of public fears concerning individuals with mental health conditions.14,15 Television portrayals do little to convince the public that individuals with mental illnesses do recover; and are active and productive members of our society.16 A recent study analyzed references to mental health in three months of television programming in the UK.17 The results revealed that 63 percent of the references to mental health in the program dialogue were pejorative, flippant or unsympathetic; terms included “crackpot,” “a sad little psycho,” “basket case,” and “looney tunes.” Forty-five percent of programs featuring mental illness-related storylines portrayed people with mental health conditions as dangerous, while 45 percent had sympathetic representations of individuals with mental illnesses. Key themes in the characterisation of people with mental health conditions included representations as being dangerous outsiders and tragic victims deserving of sympathy.

Impact of negative public attitudes

There are significant consequences to the public misperceptions and fears. Individuals are more likely to support or condone forced legal action and coerced treatment for individuals living with mental health conditions if violence is perceived to be at issue.18 The association of violence with mental illness has been used to justify bullying, as high rates of victimization have been recorded for this group.

A UK study found that psychiatrists who associated mental illnesses with violence were more likely to give a diagnosis of schizophrenia, if a history of violence was included in the case history.19 This finding has important implications, not only because of the stigma often experienced with a diagnosis of schizophrenia, but also because it is essential to ensure that individuals receive appropriate diagnosis and treatment.

Violence and discrimination are often linked. Discrimination refers to actions taken to exclude or treat others differently because of their identity, including race, ethnicity, gender, sexual orientation, disability and/or other factors, and violence is often the vehicle through which discrimination is acted out.20 Experiences of discrimination and violence can result in psychological distress and feelings of low self-esteem, as well as anxiety and depression.21 Such experiences can impede recovery, and create multiple barriers to accessing the social determinants of health, including housing, employment and education. Being a victim of violence is also strongly associated with substance abuse and mental health conditions.

Stigma and discrimination also impact other issues in one’s life, such as employment, housing, interpersonal relationships and encounters.22 Research has shown that the general public is more likely to reject a relationship with someone with a mental illness and less likely to recommend them for a job. 23,24 As a result of these type of situations, individuals with mental illnesses often are hesitant to disclose matters pertaining to their mental health.25

Stigma and discrimination are daily realities for people with a mental illness, and they report that both the fear and reality of how others judge them is one of their greatest barriers to a complete and satisfying life. Stigma and discrimination against people with a mental illness can impede recovery and diminish quality of life.

A look at the research on violence and mental health

Research regarding violence and mental health includes federal, provincial and municipal crime statistics, medical research, and investigative reports by the media. However, there is minimal critical social science research conducted on this topic, and even fewer studies that incorporate the perspectives of people living with a mental illness or their families. Furthermore, there is a lack of Canadian and Ontario-specific research on violence and mental health, which also raises the question whether studies conducted in the United States, in Europe or Australia can be generalized to the Canadian population.

Challenges in understanding the data

The existing research on violence and mental health raises more questions than answers. A majority of the known research studies focus on estimates of the rates of violent incidents, defined as prevalence. However, violence itself may be defined in different ways, and regardless of the definition, it is difficult to measure. While some studies rely solely on official documentation, other data is based on uncorroborated self-reports.26These types of limitations are well known sources of research bias. Furthermore, common sources of data, such as the use of police databases or hospital-based studies of involuntarily committed inpatients, do not represent the overall population of people living with mental illnesses.27Therefore, prevalence rates will differ depending on the source of information.

Information Gaps

A definitive causal relationship between mental illnesses and violence has not been established.

There are no population-based Canadian studies looking at violence or victimization among people with serious mental illnesses.

Some studies do not distinguish between mental illnesses, substance abuse/dependence or co-occurring mental illnesses and addictions.