Crime victimization is common among
persons with mental disorders who live in the community1, 2, 3,4,5,6
People who are assaulted have an increased risk of psychiatric
symptoms and long-term psychiatric disorders7, 8, 9.
Studies of clinical populations also indicate high rates of lifetime
victimization of psychiatric patients10, 11.
Not only may assault be a risk
factor for psychiatric disorders, but mental illness may be a risk
factor in victimization12. Once mental illness develops,
a symptomatic individual may be subjected to more assault13,
Criminal victimization of those with
severe mental illness has been associated with more severe clinical symptoms1,4,
substance misuse2,4 transient living conditions (including
homelessness)2, lower functioning, lack of social support and a
history of previous victimization1.
Since de-institutionalization, much
has been written about the risk posed to members of the public by those with
severe mental illness8. The overall evidence, however, is that the
contribution made by those with psychosis to violent crime in society is small
and is accounted for by a small minority of patients15 Conversely,
little attention generally is paid to the risk posed to this vulnerable group
of people. Cross-sectional surveys have reported the prevalence of criminal
victimization to be high among mentally ill people1,2,4 The only
case–control study to date has found those with severe mental illness at
significantly increased risk of violent victimization compared with
neighborhood controls, after controlling for socio-economic disadvantage and
the individual’s own violent behavior 5.
It was found that 15.2% of 270 acute
psychiatric inpatients had been hit, forced to have sex, or
threatened or attacked with a weapon within the preceding 10 weeks5.
In another study it was observed that 38% of 172 outpatient clients with
schizophrenia had been victimized within the preceding 3 years; 91%
of the incidents were violent4. It is reported that 10%
of persons with severe mental illness who had been deemed suitable
for enforced community treatment post-discharge were victimized in
the first year1. Men are less likely than women to be victims of
physical, emotional and sexual abuse from their partners16.
It is becoming increasingly clear
that there is a need to refocus the issue of community risk away
from the danger posed by mentally ill individuals to the danger
posed to them from other members of society15. This has
been highlighted by an American finding that patients with psychosis
living in the community are 14 times more likely to be the victims
of a violent crime than to be arrested for such a crime4
Routine psychiatric examination
often fails to uncover abuse. However, standardized interviews that
inquire directly about exposure to traumatic events tend to find
high rates of victimization within families.
index study explored the extent to which female psychiatric patients are the
victims of corporal abuse by family members.
The study was conducted at Institute of Mental Health and Hospital, Agra. The female patients admitted to the in-patient
unit and Family ward of the Institute from May 2006- April 2007 served the
study sample. Informed written consent was obtained from both guardians and
patients. The patients were physically examined for any visible physical
injury. They were interviewed in detail for the injury. Patients without any
physical injury were also interviewed for any type of physical, sexual and
emotional abuse by the family members. Information was also collected from the
family members to confirm the statements given by the patients. For excited,
mute and uncooperative patients, the researcher had to wait for interview and
examination till such patients became ready to respond to the interview. The
patients who failed to cooperate, who had to be discharged in a couple of days,
did not give consent, and whose family members were not available got excluded
from the study.
Results and Discussion
681 female patients were admitted in
the in-patient facility of the institute during May 2006-April 2007. 8 patients
did not give their consent for participation, 5 patients got discharged early
due to unavoidable familial reasons, 4 patients did not cooperate, 9 patients’
family members denied the statements given by the patients and reported other
reasons for abuse and 6 patients’ family members were not available during the
study. The data were gathered for 649 patients. The demographic and clinical
characteristics of the patients are displayed in the following tables.
Characteristics of the Patients
Age (in years)
illness (in years)
Among 649 patients 56.95% were
psychotic, 18.24% were having bipolar disorder, 19.58% were having depression
and 5.23% were mentally retarded. Physical abuse was reported in 59.49%of
cases. Visible physical injury was evident in 5.55% cases. The increased number
of victimization in schizophrenia and other major psychiatric disorders may be
due to increased psychopathology which is not present in case of MR.
Relationships with the
patient who inflicted corporal abuse are depicted in following figure.
In majority of cases (41.60%) the
physical abuse was done by husbands of the patients followed by in-laws
(17.67%), parents (13.25%) and siblings (10.17%). Similar findings were also
reported by Hegarthy19 who reported that in most of the cases women
are the victims of physical, emotional and sexual abuse by their partners.
Husbands, in-laws and parents are the next immediate persons who are liable to
take the overall responsibilities of the patient may be overburden. Due to
increased burden they usually develop low tolerance and to control the
situation they physically abuse the patient.
The nature and magnitude
of the abuse is depicted in following figure.
The most common physical abuse was
slapping by family members (52.08%) followed by beating (23.57%), hair pulling
(12.48%), tying in rope (10.17%). The more serious abuse that is, attempt to
hang was found in 1.69% cases. Slapping and hair pulling are the minor form of
physical abuse which family members opt to control the situation. But beating,
tying in rope and attempt to hang are the serious forms of physical abuse which
may cause damage and sometimes death of the patients.
Significant proportion of female
psychiatric patients reported physical abuse. Majority of cases reported mild
form of physical abuse such as slapping hair pulling. 1.69% patients reported
serious form of physical abuse. Husbands are the victimizer in most of the
In general crime victimization can
cause anxiety, depression and PTSD. In patients with mental disorder
victimization can exacerbate existing disorder, increase hospitalization and
reduce quality of life. To reduce victimization and its consequences family
education is warranted. Education about modifiable risk factors can help the
family members to develop skill that enhance personal safety, improve conflict
management and decrease their vulnerability.
Like most prior studies of persons
with severe mental illness, we sampled persons receiving treatment,
which limits generalizability.
Hiday VA, Swartz M, Swanson JW, Borum R, Wagner HR (2002).
Impact of outpatient commitment on victimization of people with severe mental
illness. American Journal of Psychiatry. 159:1403-1411
Hiday VA, Swartz MS, Swanson JW, Borum R, Wagner HR (1999).
Criminal victimization of persons with severe mental illness. Psychiatric
Buila S (2001) Crimes against people with mental illness: types, perpetrators,
and influencing factors. Social Work; 46:115-124.
Prindle C, Bae SW, Long JD. (2001) Risks for individuals with schizophrenia who
are living in the community. Psychiatric Services; 52:1358-1366.
E.(2002) Mental disorder and violent victimization: the mediating role of
involvement in conflicted social relationships. Criminology; 40:191-212.
Linn LS.(1984) Crimes against discharged mental patients in board-and-care
homes. American Journal of Psychiatry. 141:271-274.
Frank F, Anderson PA(1987) Psychiatric disorders in rape victims: past history and current
symptomatology. Comprehensive Psychiatry 28:77-82,
Mullen PE, Romans-Clarkson SE, Walton VA, et al (1998): Impact of sexual and physical abuse on women's mental health.
George LK, Swartz M, et al(1990): Sexual assault and psychiatric disorders
among a community sample of women. American Journal of Psychiatry 147:335- 341,
DS, Kaplan ML, Sorkern J, et al(1996) Prevalence and characteristics of
physical and sexual abuse among psychiatric outpatients. Psychiatric Services
11. Bryer JB, Nelson BA, Miller JB, et
al(1987) Childhood sexual and physical abuse as factors in adult psychiatric
illness. American Journal of Psychiatry 144:1426-1430,
Zimmer C(1994) Social networks, social support, and violence among persons with
severe, persistent mental illness, in Violence and Mental Disorder. Edited by
Monahan J, Steadman HJ. Chicago, University of Chicago Press
Gentry JH, Schlegel P: Reason to Hope (1994) A Psychosocial Perspective on
Violence and Youth. Washington, DC, American Psychological Association,
Hiday VA (1995) The social context of mental illness and
violence. Journal of Health and Social Behavior 36:122-137,
15. Walsh, E., Buchanan, A. & Fahy,
T. (2002) Violence
and schizophrenia: examining the evidence. British Journal of Psychiatry, 181,
Linda A. Teplin,
Gary A. McClelland,
Karen M. Abram
Weiner,(2005)Crime Victimization in Adults With Severe Mental Illness
Comparison With the National Crime Victimization Survey
General Psychiatry 62:911-921
Zimmer C, Lachicotte WS, et al(1994)The influence of social networks and social
support on violence by persons with serious mental illness. Hospital and
Community Psychiatry 45:669-679,
E., Burgess, P., Wallace, C., et al (2000) Community care and criminal
offending in Schizophrenia. Lancet, 355, 614–617.
Feder G, Ramsay J. (2006) Identification of partner abuse in health care
settings: Should health professionals be screening? In Roberts G, Hegarty K,
Feder G, editors. Intimate partner abuse and health professionals. Elsevier, London,