Psychosis and Violence
The complex relationship between psychosis and violence is at the heart of forensic psychiatric practice. The rare cases of serious violence committed by mentally disordered perpetrators are disproportionately important in the socio-political perception of the size of the need for secure psychiatric services. In the United Kingdom, the case of Christopher Clunis, who killed Jonathan Zito in 1992, is often cited as having been especially important in refocusing the socio-political agenda on public protection rather than on care and welfare of those with severe mental illness. In fact the contribution of schizophrenia to societal violence is modest, with a population attributable risk for screening positive for psychosis of 1.2% suggested in the United Kingdom,1 and there is no evidence that the rate of mentally disordered homicides has increased as a result of the reduction in psychiatric beds over recent decades.2 The research effort has been directed to establishing whether a general association exists between having a psychotic mental disorder and being violent, and whether particular symptoms of psychosis are associated with an increased risk of violence. Recently, researchers have begun to examine these broad relationships, seeking to understand the additional factors that might mediate such relationships in individuals.