Mental Illness and Violence – Access to Mental Health Services and Multidisciplinary Approach Priorities

Abstract

The relationship between mental disorder and violence still remains extremely important for both professionals and the general public. Is it possible to reduce the risk of violent behavior? The study of these issues is crucial both in terms of public health and for the proper planning and development of mental health services A national reform of mental healthcare in Georgia has been undergoing for the past fifteen years with the aim of moving to a balanced care model, developing community services and promoting reintegration of people with mental disorders into the community. This, in turn, requires a better understanding of the risk factors of violent behavior to address complex needs of these people. The aim of this survey was to explore relationship between clinical needs, treatment engagement and violence in patients with schizophrenia and schizophrenia spectrum disorders (SSD) using case control design. Cases were defined as patients with SSD who have committed at least one act of violence in the past. Controls were gender-and age matched patients with SSD who have never committed such acts of violence.  94 patients were assessed in case group and 106 patients in control group. We studied the impact of various potential risk factors on each person through patient interviews and medical records. Study results showed that the data were quite variable depending on the type of treatment setting. According to survey results, the dynamic interaction of social and contextual factors with treatment engagement played an important role as determinants of violence. Study results demonstrated that access to mental health community services and multidisciplinary team approach was associated with a better outcome for individuals with SSD. Therefore, studies of violence among individuals with mental disorders should go beyond linking various conditions or types with severity or frequency of violence, and instead focus on in-depth research on contextual and comorbid factors to identify the complex patterns of interaction. Only with such an approach is it possible to plan appropriate interventions and provide to patients in community settings. Finally, reliable data are needed to properly inform the public about the relation between mental illness and violence, to avoid potentially unwarranted stigmatization associated with mental illness.