Deadly Trouble for Troubled Minds

Mentally ill more likely to be murdered, study says

THURSDAY, Dec. 20, 2001 (HealthDayNews) -- People with mental illnesses, including drug and alcohol abuse, are more than six times as likely as the rest of the public to be murdered, European researchers say.

It's well known that people with mental disorders are more likely to commit suicide, and evidence shows that they are also more prone to being involved in violence. But the new research is the first to consider whether they're at an increased risk of being killed by others.

The researchers, whose work appears in this week's The Lancet, say they're not sure why the mentally ill are more at risk than emotionally healthy people of suffering violent deaths. However, they suggest several potential explanations, from living in undesirable and unsafe neighborhoods to being assaulted for looking and acting differently.

"The illness itself may make them more vulnerable," says Dr. Louis Appleby, a psychiatrist at the University of Manchester in England and a co-author of the study. "Mental illness and paranoia might provoke a degree of ridicule and hostility, which in a small number of people has this kind of tragic consequence."

The government says 20 percent of Americans, or some 53 million people, develop some form of mental illness each year. Ten million suffer from severe emotional disorders.

The study looked at more than 72,000 Danes who were registered with that country's national database of the mentally ill between 1973 and 1993. Approximately 17,900 of them died of unnatural causes before 1994.

Murder was extremely rare, accounting for 181, or 1 percent, of the deaths in Denmark. Of the rest, 12,977, or 73 percent, were suicides, and 4,734, or 26 percent, were accidents. Across the entire U.S. population, only about 14,500 people were murdered in 1999, a percent of the population that tracks well with the Danish results.

Not surprisingly, the researchers say, drug users and, to a lesser degree, alcoholics, were at the greatest risk of falling victim to homicide. Yet schizophrenics, psychotics and even those with learning disabilities had higher-than-normal odds of being murdered.

Men with mental problems were generally more likely than women to be killed, the researchers say, although for certain conditions, such as psychosis caused by a physical ailment, that trend was reversed.

Overall, Appleby's groups says, the rate of murders among the mentally ill were between six and seven times higher than that for Denmark as a whole.

Appleby notes that Denmark is considered a relatively safe country with a reasonably good system of caring for its mentally ill. In the United States, which has much more violent crime, "the results of our study might not only be replicated but worse," he says.

Dr. Paul Appelbaum, a psychiatrist at the University of Massachusetts in Worcester, who has looked at violence and the mentally ill, says several studies show that emotionally disturbed people are more likely to be victims than victimizers.

"In this country, many people with serious mental illnesses live in neighborhoods that are high-crime neighborhoods, because it's where they can afford or where it's possible to establish group homes," Appelbaum says. "So it wouldn't be surprising to see higher rates of victimization."

Appelbaum says many people with mental illness also have problems with drugs and alcohol that might increase their risk of getting into dangerous situations.

Sara Thompson, director of adult mental health services at the National Mental Health Association, in Alexandria, Va., says the latest work underscores the need for better understanding of emotional disorders.

"There's a huge stigma attached to mental illness because people think that people with mental illness are violent, and that may lead to violence in and of itself," Thompson says.

Recognizing that the opposite is true, she says, society should also try to offer the mentally ill housing and services in areas where they're not at risk of violence.

What To Do

For more on mental illness, try the National Mental Health Association or the American Psychiatric Association.

The American Psychological Association has information to help you recognize the warning signs of violence.

SOURCES: Interviews with Louis Appleby, M.D., professor of psychiatry, University of Manchester, England; Paul Appelbaum, M.D., professor and chair of psychiatry, University of Massachusetts Medical School, Worcester; Sara Thompson, LCSW, director of adult mental health services, National Mental Health Association, Alexandria, Va.; Dec. 22/29, 2001, The Lancet
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