Drink and drug abuse blamed for violence by mentally ill

Mental illness is not to blame for the number of violent crimes committed by patients, a study showed today.

Drug and alcohol abuse is the reason why mentally ill people carry out acts of violence, researchers found.

Dr Seena Fazel, clinical senior lecturer in forensic psychiatry and honorary consultant forensic psychiatrist at the University of Oxford, said: "Most of the relationship between violent crime and serious mental illness can be explained by alcohol and substance abuse.

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"That tends to be the thing that mediates the link between violence and the illness."

He said "if you take away the substance abuse, the contribution of the illness itself is minimal" or even non-existent.

Mental illness has a huge stigma attached to it when, actually, part of the solution would be to tackle substance and alcohol abuse.

Dr Fazel added: "It's probably more dangerous walking outside a pub on a late night than walking outside a hospital where patients have been released."

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Studies have shown that about 20 per cent of people with bipolar disorder abuse alcohol and drugs compared with about 2 per cent of the general population.

A quarter of people with schizophrenia abuse drugs and alcohol.

Dr Fazel said these groups often use drugs and alcohol as a way of getting relief from their psychiatric symptoms or as a way of countering the effects of medication, which have a sedative effect.

His latest study was carried out in Sweden, which collected a wide range of reliable data, and which is very similar to the UK in terms of crime and rates of mental illness.

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Dr Fazel and colleagues found that rates of violent crime among people who were mentally ill and abused substances were no different to those among people who abuse substances in the general population.

People with mental illness and substance abuse have violent crime rates which are six to seven times higher than the general population.

And members of the public who abuse substances also have violent crime rates which are six to seven times higher than the general population.

Dr Fazel said data also showed that those who are mentally ill and do not abuse substances are only at "minimally increased risk" of committing violent crime. About 0.9 to 1 per cent of the general population suffers from bipolar disorder while 0.4 to 0.5 per cent have schizophrenia.

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Bipolar disorder is commonly known as manic depression and is characterised by mood swings from one extreme to another.

People with bipolar disorder have periods or "episodes" of depression where they feel very low and periods of mania where they feel very high.

Each extreme episode can last for several weeks or longer, and often interfere with daily living.

Schizophrenia causes a range of psychological symptoms including hallucinations (hearing or seeing things that do not exist) and delusions (believing things that are untrue).

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The latest study was published in the journal Archives of General Psychiatry. It involved almost 4,000 patients with bipolar disorder, more than 37,000 people in the general population and

more than 4,000 siblings of people with bipolar disorder

but who were unaffected themselves.

Dr Fazel said including siblings was an important factor because it meant researchers could control for the influence of genetic factors and environmental factors in early childhood.

Marjorie Wallace, chief executive of mental health charity Sane, said: "We accept that alcohol and drug abuse can exacerbate the more acute symptoms and that such abuse is more widely responsible for criminal acts.

"We also accept that the majority of people with mental illness are never violent and the chances of a member of the public being attacked at random extremely rare.

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"However, we do not believe it is helpful to underplay the extreme pain, paranoia and denial of symptoms such as command voices which those with psychosis can experience and which may trigger damaging behaviour."

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