Are Psychiatric Patients Violent?

Recently, there was an attack at Hospital Selayang, with a patient stabbing another patient 3 times, prompting news channels to write about it.

“Report: Psych patient stabs elderly man at crowded Selayang Hospital”

“Psychiatric patient stabs person at Selayang Hospital”

“Psychiatric patient who stabbed fellow patient in Malaysia hospital had been brought in by police”

“Victim stabbed by psychiatric patient at Selayang Hospital in stable condition”

“Report: Selayang Hospital Patient Stabbed By Another Patient Stranded In Emergency Department”

“Cops investigate stabbing incident at Selayang Hospital”

It is very unfortunate that this incident occurred and we’re all very grateful that the victim in this stabbing survived the attack and is now recovering in the ICU. He has our well wishes and we pray for his quick recovery.

We do, however, want to look into the possibility of something like this occurring again and prevent it. With titles such as those above, one would wonder whether psychiatric patients are more aggressive? Are they dangerous? Should we be worried or avoid them?

Unfortunately this then feeds into the stigma of mental health.

The majority of psychiatric patients are not aggressive, in fact, most psychiatric patients are 10x more likely to be at risk of being abused by other people and are victims of violent crime.

We don’t have good studies here in Malaysia, but studies in the US would show that only 3-5% of violent attacks are committed by patients with serious mental illness, the rest are by people without mental illness.

"only 3-5% of violent attacks are committed by patients with serious mental illness"

When we talk about aggression in the psychiatric patients, most studies would show that the aggression tend to be inwards, towards the self, consisting of self injury through hitting their heads, punching a wall and hurting their hand, or attempting to commit suicide. Aggression towards other people are in the minority.

Let’s look at the facts, there are some psychiatric disorders that could increase the chance of patient’s becoming aggressive, for example - patients suffering from dementia, especially frontotemporal lobe dementia (loss of the part of the brain that controls executive function or higher level function/planning).

The second psychiatric illness that could increase aggression would be patients with substance use disorders. In fact, this would likely be the highest risk among non-cognitively ill patients. Patients who abuse stimulating agents are more likely than other substances to be aggressive, for example, cocaine, PCP, amphetamines.

There is a slight increase in risk of aggression in patients with schizophrenia, specifically for those with “command hallucinations”, where they hear voices telling them to do things, but even then, the risk is slight compared to the general population.

Again, most of the aggression are directed towards themselves and not towards other people. In this event that occurred in Hospital Selayang, we do not have enough information regarding what exactly happened and therefore it would be unfortunate to contribute to the stigma about violence among patients suffering from mental illness.

References

1. Appelbaum PS. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006 Aug;163(8):1319-21. doi: 10.1176/ajp.2006.163.8.1319. PMID: 16877640.