Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods

Abstract

FOR 75 YEARS, studies have attempted to estimate the prevalence of violence committed by people discharged from psychiatric facilities in the United States, and to compare that rate with the prevalence of violence by others in their communities.^1-3 These studies have been invoked in legal and policy debates concerning standards for hospital admission and discharge, for community placement and monitoring, and for tort liability.⁴ Four methodological problems consistently have compromised this work: (1) existing studies use weak markers for the occurrence of community violence, such as reliance solely on official arrest records,⁵ rehospitalization records,⁶ or uncorroborated self-reports (see Swanson et al⁷; compare Lidz et al⁸); (2) due to these weak markers, descriptive information essential for understanding violence in context is often missing from existing studies⁹; (3) existing studies rarely have reported data on the timing of violent acts, despite the implications for intervention that timing may have¹⁰; and (4) existing studies have tended to enroll only subjects who are presumed to have a high base rate of violence; eg, men with a history of violence.^8,11 Because different factors may be associated with violence among men than among women, and with repeated violence than with the first occurrence,¹² these inclusion criteria limit the generalizability of reported findings.