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Mental Health and Violence

From BBC News:

Bipolar disorder ‘not to blame for violent behaviour’

People with a severe mental illness are no more likely to be violent than anyone else – unless they abuse drugs or alcohol, a study has suggested.

[source]

I read this article with interest because it reminded me of when, some years ago as new Emergency Care Practitioners, we were having a round table discussion about the safety of us, as single responders, being sent to patients with mental health problems.  Some felt that the risks were too great and we should not be sent to these calls on our own. I didn’t agree however, and I went off to undertake a little research of my own. I found various articles that supported my belief that it is the binge drinking and drug taking population who tend to give us the most problems – rather than people with a mental health diagnosis. According to The Mental Health Foundation on average 1 in 4 people will experience some kind of mental health problem in the course of a year. Only a minority of these will be diagnosed with a serious ongoing mental health problem. The majority of patients with mental health problems will be at the ‘soft end’ of the scale and therefore are unlikely to cause us any problems through violence.

This article discusses the study led by Oxford University’s Department of Psychiatry where the relationship between bipolar disorder and violence was observed and compared to the wider population. In conclusion it supports the view of mental health charities who argue that the stigma attached to mental illnesses is not justified by medical evidence.

I started thinking about the occasions when I have been assaulted or verbally abused while going about my duties in the past. While I have worked for over 20 years in the NHS, I have yet to recall a single incident where mental health was the sole contributory cause for the incident. For me alcohol abuse stands out as the single most important factor. A fact that is borne out by the British Medical Association, who in 1995 found that alcohol was a factor in:

  • 60-70% of homicides
  • 75% of stabbings
  • 70% of beatings
  • 50% of fights and domestic assaults

Further to this, binge drinking is evident in 24% of violent incidents reported to the police and binge drinkers were more likely to offend than other drinkers. They account for a disproportionate amount of the total number of crimes. I am sure that my colleagues in the ambulance service and police will bear testament to this, particularly those who work weekend nights.

During one memorable job last week, both me and my colleagues were covered in our drunken patient’s vomit as she lashed out and flailed about on the floor. She had managed to get vomit all over her own face and hair – even in her eyes. She kept exposing herself to neighbours and onlookers despite our best efforts to cover her up – and the wailing and crying – need I go on?

I have a simple idea though! We should have been allowed to take photographs of her in that undignified state. If she struggled to recall the events of the day before, these photos – obviously for her eyes only – would serve to redress the issue of her amnesia (those of us who witnessed it need no further reminder as the episode is forever indelibly etched in our minds). When she is handed the damning photographs she can then ponder over them at her leisure while she nurses her hangover and hopefully she will consider the atrocious spectacle she made of herself in front of her friends and neighbours as well as the not insignificant cost to the emergency services.

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