COMMENTARY

What if You Suspect That Your Patient Is Violent or Mentally Ill?

Arthur Caplan, PhD; Paul S. Appelbaum, MD

Disclosures

February 04, 2014

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In This Article

The Issue of Gun Violence

Arthur L. Caplan, PhD: Hi. I want to welcome you to Close-Up. I'm Art Caplan from the New York University Langone Medical Center, and today my guest is Dr. Paul Appelbaum, with Columbia University and the New York State Psychiatric Institute. Paul is probably one of the most distinguished American psychiatrists, someone who I have read for many years and learned a lot from. Thank you so much for being here today.

Paul S. Appelbaum, MD: Thank you for that kind introduction, Art. It is a pleasure to be here.

Dr. Caplan: Let me get into a set of questions about a challenging issue we seem to have in the United States: gun violence. I am asked by many physicians who are not psychiatrists, psychologists, or mental health workers about what to do if they have a suspicion about somebody potentially being violent, someone potentially causing harm. How do they handle that?

Dr. Appelbaum: The first thing to know and to recall in a circumstance like that is that most people with mental illness are not violent, ever, and although there is a somewhat increased rate of violence associated with mental illness, the assumption that because somebody is mentally ill then they will become violent is simply false. In fact, people with mental illness are much more likely to be victims of violence than they are to be perpetrators of violence.

That being said, there are some groups of people with mental illness, just as there are groups of people without mental illness, who are at increased risk for violence. The risk factors are age (young people are at greater risk than older people), sex (men are at much greater risk than women), and substance abuse. Of all the substances of abuse, alcohol, the only legal one, is the highest risk indicator. People who are dispositionally angry, hostile, or suspicious, [as well as those who experience] certain kinds of psychotic phenomena(including hearing voices that command them to perform a violent act, and certain kind of delusions -- delusions of persecution) are at increased risk.

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