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Mentally ill adults suffer high rates of Crime Victimization.

More than one-quarter of Chicago-area adults with serious mental illness had been the victims of crime over the past year, according to a study by Linda A. Teplin, Ph.D., and her colleagues at Northwestern University, Chicago.

This rate is more than 11 times higher than that found in the general population--even after controlling for demographic differences, the researchers said (Arch. Gen. Psychiatry 2005;62:911-21).

Compared with the general population, adults with serious mental illness (SMI) were 140.4 times more likely to suffer a personal theft during the past year, 17 times more likely to suffer a rape or sexual assault, and 15 times more likely to be the victim of assault.

The study involved interviews with a probability sample of 936 adults with SMI from 16 randomly selected agencies that provided outpatient, day, and residential treatment. All subjects met criteria for psychosis or major affective disorder. The investigators used measurement instruments identical to those used by the annual National Crime Victimization Survey (NCVS), which is administered by the U.S. Department of Justice.

For purposes of comparison, inner-city NCVS data for 1997-1999, the same time period as the SMI interviews, were corrected for race, ethnicity, sex, age, and income. This was done because adults with SMI are more likely than the general population to be poor, and poverty is strongly correlated with victimization.

Among people with SMI, there were 168.2 incidents of violent crime per 1,000 persons per year, 4.2 times higher than the rate of 39.9 incidents per 1,000 persons per year among the general population.

The incidence of rape or sexual assault among people with SMI was 8.39/1,000 persons per year, 12.3 times as high as the general population. Personal theft (theft of property from a person) was 142.6/1,000 persons per year, 59.7 times as high as the general population.

People with SMI also had significantly higher rates of most property crimes with two exceptions: There was no significant difference in rates of motor vehicle theft, and they had a significantly lower rate of attempted property theft.

In an accompanying editorial, Leon Eisenberg, M.D., of Harvard Medical School, Boston, noted that while mental illness is associated in the public mind with violence, this study shows that the true direction of causality is the reverse of the common belief: People with SMI are far more likely to be the victims of violence, rather than its perpetrators (Arch. Gen. Psychiatry 2005;62:825-6).

"I think it's a landmark study documenting with standard, reliable instruments the extent to which mentally ill persons are the victims of crime," Dr. Eisenberg said in an interview with this newspaper. "Lots of people believed this to be true before, but nobody had any firm data."

The study has an important message for psychiatrists, he said. "Its message is to be concerned with the living circumstances of the patient. It's not enough to provide good in-house care, that is in the office or in the clinic or when the patient visits. It's important to extend our interest to the life circumstances of the patient, and to help the patient negotiate the various social agencies and social resources that may make life more satisfying."

Dr. Teplin and her associates made several policy recommendations. They said that housing options for people with SMI must be improved and crime prevention programs for people with SMI initiated. Psychiatrists have an important part to play there as well, Dr. Eisenberg said. "One of the roles of a physician is being an advocate for patients."

In addition, "teach patients self-care: where you ought not to walk; what you ought to worry about; and how you increase your safety," he said.


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Title Annotation:Forensic Psychiatry
Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1U3IL
Date:Dec 1, 2005
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