Severe mental illness and the risk of violence | Letters

Your report of Sarah Hughes’s acknowledgment that 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 resourced services, continuity of care, assertive follow-up and thoughtful 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.
Prof John F Morgan
Consultant psychiatrist, Harrogate, North Yorkshire