Mental Illness Risk Assessment

There are three things you need to know to assess risk from someone who suffers from severe mental illness.

FIRST: Most people with severe mental illness are not violent.

97.1% of people with a severe mental illness are not violent.

If you add substance abuse to severe mental illness that number drops to 90%. So, that means, even of people who suffer from severe mental illness AND addiction, 9 out of 10 people are not violent.

Source: eangelis, Tori. “Mental Illness and Violence: Debunking Myths, Addressing Realities.” Monitor on Psychology, Apr.-May 2021, pp. 31─36.

SECOND: Some symptoms are more likely than others to lead to violence.

Our team put together the following chart of symptoms:

The easiest way to remember this chart is that there are only four high-risk symptoms:

1. Command Hallucinations – Voices telling a person to harm others (or themselves)

2. Persecutory Delusions – Paranoid delusions that someone is out to get the person.

I don’t worry about these unless the person has access to the supposed persecutor.

For example, if the person thinks the President of the United States is out to get them, I am not too worried. If they think that one of my staff is trying to harm them, I am very worried.

3. Romantic Delusions – Stalking should always be taken seriously.

4. Suicidal Ideation – Suicide should always be taken seriously.

THIRD: I have a quick test for whether a hallucination or delusion is dangerous.

Ask yourself: How would a typical person respond if this delusion or hallucination was real?

For example, I knew a guy who thought that a specific staff member of a homeless shelter was spraying him with poison every night while he slept.

The shelter employees were not taking it seriously until I asked, “If someone actually sprayed you with poison every night, what would you do to them?”

The response was, “Oh, I’d kill them.”

“Exactly!” I said.

By the way, this is a “Persecutory” Delusion where the individual has access to the supposed persecutory. It is in the VERY High Risk column above.

On the other side, I knew a woman who thought she was the Queen of England.

There is nothing about that delusion that would inherently lead to violence.

Most delusions are like this.

Hope this helps!

From

Ryan Dowd at http://www.homelesstraining.com/