Severe mental illness and the risk of violence | Letters

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Severe mental illness and the risk of violence

A new willingness to acknowledge the risk that some people with severe mental illnesses may become violent is welcomed by Prof John F Morgan

Your report of Sarah Hughes’s acknowledgment that <a href="https://lumeamara.online/?p=6690" title="Prioritise mental health, financial discipline, experts urge women entrepreneurs”>mental health organisations have sometimes “softened the truth” about the relationship between serious mental illness and violence marks an important change in the public debate (Mental health groups have ‘failed to acknowledge’ risk of violence, says Mind chief, 5 September)

There is some historical irony here. Mind grew from the National Association for Mental Health, an organisation in which psychiatrists and other mental health professionals played an important part. From the 1970s onwards, Mind increasingly defined itself as an independent campaigning organisation and, at times, a vigorous critic of psychiatric practice and authority

As a psychiatrist who previously chaired the Royal College of Psychiatrists group concerned with risk, and who gave evidence to the Nottingham inquiry, I have seen the consequences of our difficulty in discussing this subject plainly

Psychiatrists have long had to hold two propositions together. The overwhelming majority of people with mental illness are not violent and should not be stigmatised as such. But some severe mental disorders, particularly when accompanied by factors such as substance misuse, disengagement from treatment or a previous history of violence, can materially increase risk. Acknowledging the second proposition does not contradict the first.

Indeed, avoiding discussion of risk for fear of stigma can itself have consequences for patients, families and the wider public. Properly reghtful risk assessment protect patients as well as others

It is therefore significant that Mind is now prepared to say publicly that the mental health charity sector has sometimes been too reluctant to acknowledge an uncomfortable reality. This should not become an argument between psychiatry and its critics. It is an opportunity for clinicians, patients and campaigning organisations to recover a more mature position: opposing stigma while being equally willing to speak honestly about risk.ProfJohn F MorganConsultant psychiatrist, Harrogate, North Yorkshire

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