Multiple studies have shown that individuals with severe mental illness are especially vulnerable to being victimized. This frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed.

BACKGROUNDER
Updated March 2011

SUMMARY: Multiple studies have shown that individuals with severe psychiatric disorders are especially vulnerable to being victimized. This frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed. Women who have a severe psychiatric disorder are especially vulnerable. Some of the studies suggest that individuals who are victimized are less likely to have been compliant with their medication. This association is strongly supported by the 2002 North Carolina study by Hiday et al. that showed that individuals with severe psychiatric disorders who were on outpatient commitment, and thus were taking their medication regularly, were victimized only half as often as those who were not on outpatient commitment.

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• A 2009 review of victimization studies reported: “Rates of victimization among severely  mentally ill persons were 2.3–140.4 times higher than in the general population.” Victimization occurred more frequently among individuals who were also abusing drugs and/or alcohol and among individuals who had the most severe symptoms.

Maniglio R. Severe mental illness and criminal victimization: a systematic review. Acta Psychiatrica Scandinavica 2009;119:180–191.

• In 13 rural counties in Vermont, all individuals with serious mental illness who were victimized in a one-year period (July 2005 through June 2006) who came to the attention of the police were studied. If the victimization did not come to the attention of the police, it was not included. Among 2,610 individuals with serious mental illness, 7.1 percent were the victim of a crime. Among those who were 18 to 34 years of age, the percentage victimized was 13.2 percent, compared to those who were 50 or older, for whom the percentage was 4.5 percent.

Pandiani JA, Banks SM, Carroll BB et al. Crime victims and criminal offenders among adults with serious mental illness. Psychiatric Services 2007;58:1483–1485.

• In San Francisco, 103 individuals with schizophrenia spectrum disorders and 36 with bipolar disorder were asked whether they had been victimized (by robbery, rape, mugging, or assault) within the past six months. At the time of the interview, all were living in residential homes. One-third of those with bipolar disorder and one-fifth of those with schizophrenia spectrum disorders had been victimized. Females were almost twice as likely to have been victimized compared to males.

White MC, Chafetz L, Collins-Bride G et al. History of arrest, incarceration and victimization in community-based severely mentally ill. Journal of Community Health 2006;31:123–135.

• A National Crime Victimization Survey interviewed 936 patients with “chronic and severe mental illnesses.” “More than one quarter . . . [of them] had been victims of a violent crime in the past year, a rate more than 11 times higher than the general population.” The authors suggested that the study “may underestimate victimization.”

Teplin LA, McClelland GM, Abram KM et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry 2005;62:911–921.

• In a study in Connecticut, 207 patients with severe psychiatric disorders who were living in the community were followed for one year. Individuals who also were substance abusers had significantly more episodes of violent victimization then did the patients without substance abuse. Much of the victimization was said to be associated with “social isolation related to disorders such as schizophrenia [which] may lead persons with co-occurring disorders to make poor judgments about whom to trust.”

Sells DJ, Rowe M, Fisk D et. al. Violent victimization of persons with co-occurring psychiatric and substance use disorders. Psychiatric Services 2003;54:1253–1257.

• In Baltimore, data on physical and sexual abuse was collected for one year on three groups of women who were also substance abusers: schizophrenia, nonpsychotic affective disorders (e.g., depression), and not mentally ill. The results demonstrated “high rates of past year violent sexual and physical abuse,” with significantly higher risks among the women with schizophrenia.

Gearon JS, Bellack AS, Brown CH. Sexual and physical abuse in women with schizophrenia: prevalence and risk factors. Schizophrenia Research 2003;60:38.

• In Pittsburgh, 270 individuals with severe psychiatric disorders who had been recently discharged from psychiatric hospitals were followed for 10 weeks and compared with 477 neighborhood controls. During this 10-week period, 15 percent of the psychiatrically ill individuals were violently victimized compared to 7 percent of the neighborhood controls.

Silver E. Mental disorder and violent victimization: the mediating role of involvement in conflicted social relationships. Criminology 2002;40:191–211.

• In New York, New York Times reporter Clifford Levy, in a 2002 Pulitzer Prize–winning exposé, illustrated how egregiously seriously mentally ill people can be victimized. Residents of a board-and-care home in Queens were subjected to prostate surgery and eye surgery (mostly cataract surgery), most of which was completely unnecessary but done simply to generate Medicaid fees for the physicians involved. At least 24 male residents were subjected to prostate surgery, and more than 30 residents had eye surgery; at least 8 residents had both.

Levy CJ. Voiceless, defenseless and a source of cash. New York Times, April 30, 2002.

Levy CJ. Home for mentally ill settles suit on coerced prostate surgery for $7.4 million. New York Times, August 5, 2004.

• In North Carolina, detailed information on victimization was obtained on 184 individuals with schizophrenia, schizoaffective disorder, and affective disorders, who were followed for one year. Eighty-five of the individuals were on outpatient commitment for part or all of the year, and 99 were not. Victimization was classified as either a violent crime (e.g., assault, rape, or mugging) or a nonviolent crime (e.g., burglary, theft of money, being cheated) against the psychiatrically ill person. Among the 85 individuals on outpatient commitment, 24 percent were victimized, while among the 99 not on outpatient commitment, 42 percent were victimized. The authors noted: “Furthermore, risk of victimization decreased with increased duration of outpatient commitment.” Individuals in the outpatient-commitment group were victimized significantly less often despite the fact that individuals in both groups received standard outpatient care and case management services. The authors suggest that “outpatient commitment reduces criminal victimization through improving treatment adherence, decreasing substance abuse, and diminishing violent incidents” that may evoke retaliation.

Hiday VA, Swartz MS, Swanson JW et al. Impact of outpatient commitment on victimization of people with severe mental illness. American Journal of Psychiatry 2002;159:1403–1411.

• In Seattle between 1997 and 1999, 819 women who had been sexually assaulted were asked about their history of psychiatric disorders. Eighty of the women (10 percent) had been diagnosed with schizophrenia or schizoaffective disorder, and an additional 55 (6 percent) had been diagnosed with bipolar disorder or severe depression. Because of the way the study was carried out, the authors said they believed that “most likely we underreported the prevalence of major psychiatric diagnosis in this population.” Women with a severe psychiatric disorder, compared to those without such disorders, were significantly more likely to have been sexually assaulted by a stranger, assaulted by multiple assailants, and injured during the assaults. They were also more likely to have been homeless or to have spent time in jail. The authors concluded that “sexual assaults in women with a major psychiatric diagnosis are common” and “more violent” than in women without such diagnoses.

Eckert LO, Sugar N, Fine D. Characteristics of sexual assault in women with a major psychiatric diagnosis. American Journal of Obstetrics and Gynecology 2002;186:1284–1291.

• In North Carolina, 331 individuals with severe psychiatric disorders (schizophrenia, schizoaffective disorder, affective disorders with psychotic features) were questioned about victimization in the four-month period immediately preceding their psychiatric hospitalization. All 331 individuals had been referred for outpatient commitment, strongly suggesting that they were noncompliant with their medications. Of the 331 individuals, 27 (8.2 percent) had been the victim of a violent crime (assault, rape, or mugging) within the previous four months, a rate 2.7 times higher than the annual rate of violent criminal victimization in the United States. The authors point to factors that “probably caused underreporting of some victimization” and also note that the rate of violent victimization in North Carolina is lower than the rate for the United States as a whole. These facts, plus the fact that the study compared victimization for four months in the study population to one year in the control population, all suggest that the difference between the patients and controls was substantially greater. Using a multivariate analysis, the two variables that most strongly predicted criminal victimization among these individuals with severe psychiatric disorders were occasional drug or alcohol use and homelessness during the four-month period.

Hiday VA, Swartz MS, Swanson JW et al. Criminal victimization of persons with severe mental illness. Psychiatric Services 1999;50:62–68.

• In Los Angeles, 172 individuals with schizophrenia who were living in the community in stable housing were followed for three years. During that time, 34 percent of them were victimized by violent crimes (robbery, assault, or rape). Individuals who were victimized were more likely to have had more severe symptoms, although medication compliance was not assessed in this study. The authors concluded: “This finding suggests that the most ill and vulnerable persons with schizophrenia are the most likely to be victimized.”

Brekke JS, Prindle C, Bae SW et. al. Risks for individuals with schizophrenia who are living in the community. Psychiatric Services 2001;52:1358–1366.

• Seven hundred eighty-two (782) individuals with serious mental illnesses living in New Hampshire, Connecticut, Maryland, and North Carolina were asked whether they had been victimized. Within the previous year, 20 percent of women and 8 percent of men had been sexually assaulted, and 33 percent of women and 37 percent of men had been physically assaulted.

Goodman LA, Salyers M, Mueser et al. Recent victimization in women and men with severe mental illness: prevalence and correlates. Journal of Traumatic Stress 2001;14:615–632.

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