Several general conclusions are supported by this brief overview. First, mental disorders are neither necessary, nor sufficient causes of violence. The major determinants of violence continue to be socio-demographic and socio-economic factors such as being young, male, and of lower socio-economic status.
Second, members of the public undoubtedly exaggerate both the strength of the relationship between major mental disorders and violence, as well as their own personal risk from the severely mentally ill. It is far more likely that people with a serious mental illness will be the victim of violence.
Third, substance abuse appears to be a major determinant of violence and this is true whether it occurs in the context of a concurrent mental illness or not. Those with substance disorders are major contributors to community violence, perhaps accounting for as much as a third of self-reported violent acts, and seven out of every 10 crimes of violence among mentally disordered offenders.
Finally, too much past research has focussed on the person with the mental illness, rather than the nature of the social interchange that led up to the violence. Consequently, we know much less than we should about the nature of these relationships and the contextual determinants of violence, and much less than we should about opportunities for primary prevention (30). Nevertheless, current literature supports early identification and treatment of substance abuse problems, and greater attention to the diagnosis and management of concurrent substance abuse disorders among seriously mentally ill as potential violence prevention strategies (25).
