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In public perception, mental illness and violence remain inextricably intertwined, and much of the stigma associated with mental illness may be due to a tendency to conflate mental illness with the concept of dangerousness. This perception is further augmented by the media which sensationalises violent crimes committed by persons with mental illness, particularly mass shootings, and focuses on mental illness in such reports, ignoring the fact that most of the violence in society is caused by people without mental illness. This societal bias contributes to the stigma faced by those with a psychiatric diagnosis, which in turn contributes to non-disclosure of the mental illness and decreased treatment seeking,1 and also leads to discrimination against them. The association of violence and mental illness has received extensive attention and publicity. Public perception of the association between mental illness and violence seems to have fuelled the arguments for coerced treatment of patients with severe mental illness.2 ,3
However, this perception is not borne out by the research literature available on the subject. Those with mental illness make up a small proportion of violent offenders. A recent meta-analysis by Large et al4 found that in order to prevent one stranger homicide, 35 000 patients with schizophrenia judged to be at high risk of violence would need to be detained. This clearly contradicts the general belief that patients with severe mental illness are a threat.
Definition and magnitude of the problem
There are numerous ways of conceptualising the definition of violence, although at present there is no consensus as to which of these is the most appropriate. The WHO has defined violence as ‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, …
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