For people who have schizophrenia, and don't get treatment, the result is far too often that they end up homeless or in jail (most often due to minor offenses).

• Approximately 200,000 individuals with schizophrenia or manic-depressive (bipolar disorder) illness are homeless, constituting one-third of the approximately 600,000 homeless population (total homeless population statistic based on data from Department of Health and Human Services). These 200,000 individuals comprise more than the entire population of many U.S. cities, such as Hartford, Connecticut; Charleston, South Carolina; Reno, Nevada; Boise, Idaho; Scottsdale, Arizona; Orlando, Florida; Winston Salem, North Carolina; Ann Arbor, Michigan; Abilene, Texas or Topeka, Kansas.
  
• At any given time, there are more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals. Approximately 90,000 individuals with schizophrenia or manic-depressive illness are in hospitals receiving treatment for their disease.
  Source: Treatment Advocacy Center

Schizophrenia and Violence

People with schizophrenia are far more likely to harm themselves than be violent toward the public. Violence is not a symptom of schizophrenia.

News and entertainment media tend to link mental illnesses including schizophrenia to criminal violence. Most people with schizophrenia, however, are not violent toward others but are withdrawn and prefer to be left alone. Drug or alcohol abuse raises the risk of violence in people with schizophrenia, particularly if the illness is untreated, but also in people who have no mental illness. When violence does occur, it is most frequently targeted at family members and friends, and more often takes place at home.

Substance abuse (i.e. street drugs and alcohol) significantly raises the rate of violence in people with schizophrenia, as is also the case with people who do not have any mental illness. People with paranoid and psychotic symptoms, which can become worse if medications are discontinued, may also be at higher risk for violent behavior. For more information on this issue - please see:

• Predictors of Violence in People who have Schizophrenia.
  
• Crime and Schizophrenia - May, 2004 Research Report
  
• Ending Stigma by Ending Violence
• Families of mentally ill pay terrible toll: Psychiatric patients are killing and assaulting their families at an alarming rate
• Personal Story of Schizophrenia and Jail - Blog: Love Lost to the Department of Corrections
• Daily Schizophrenia Violence in the News - On any day you will find that many of the news articles (if not most) that include reference to schizophrenia relate to violence that is a result of schizophrenia. While only a small percent of people with schizophrenia are violent, when violence takes place (especially in the USA where the media focuses more heavily on crime and violence compared to other countries) any violence related to schizophrenia tends to be covered widely in the news media. Moreover, violence and fatalities in association with schizophrenia are much more common in the US due to the greater availability of hand guns and the greater difficulty of getting good treatment and services for people who have schizophrenia.
  

If you have a family member that has schizophrenia, is not taking medication and has a history of violence, we recommend you review the information on Assisted Treatment.

For more information on the preventable violence that is sometimes associated with untreated schizophrenia (and how people are working towards changing laws so that it can be avoided) please see the following web site: Treatment Advocacy Center

If you are interested in the issue of improving treatment opportunities for people with schizophrenia and reducing violence - be sure to subscribe to the free Treatment Advocacy Newsletter called "Catalyst"

Homocides and Schizophrenia:

In Out of the Shadows, published by John Wiley & Sons earlier this year, I estimated that there are now approximately 1000 homicides a year committed by individuals with schizophrenia and bipolar disorder, almost all of whom were not taking medication at the time of the homicide. My estimate was based on all cases in a metropolitan area of 4 million people for 1 year, then extrapolated to the whole country. Anecdotal evidence suggests that such cases are not unique to urban areas so I think such extrapolation is reasonable. To date, nobody has challenged this 1000/year estimate. Altogether in the US there are approximately 24,000 homicides a year.

Dr. E. Fuller Torrey

Note: I reviewed this in Surviving Schizphrenia (3rd ed., 1995), pp. 271-273. Since this was published, there have been at least three pertinent papers:

Heila et al., American J. Psychiatry 154:1235-1242, 1997

Amador et al., American J. Psychiatry 153:1185-1188, 1996

Fenton et al., American J. Psychiatry 154:199-204, 1997

Schizophrenia and Jail

The vast majority of people with schizophrenia who are in jail have been charged with misdemeanors such as trespassing.

As many as one in five (20%) of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals, according to a comprehensive study. Source: Human Rights Watch

The American Psychiatric Association estimated in 2000 that one in five prisoners were seriously mentally ill, with up to 5 percent actively psychotic at any given moment.

In 1999, the statistical arm of the Justice Department estimated that 16 percent of state and federal prisoners and inmates in jails were suffering from mental illness. These illnesses included schizophrenia, manic depression (or bipolar disorder) and major depression.

The figures are higher for female inmates, the report says. The Justice Department study found that 29 percent of white female inmates, 22 percent of Hispanic female inmates and 20 percent of black female inmates were identified as mentally ill.

Many individuals with schizophrenia revolve between hospitals, jails and shelters. In Illinois 30% of patients discharged from state psychiatric hospitals are rehospitalized within 30 days. In New York 60% of discharged patients are rehospitalized within a year. Source: Surviving Schizophrenia

Schizophrenia and Violence - Articles

Schizophrenia: Mentally ill jamming Canadian jails

Additional Resources - The Problem:

Homelessness: The Tragic Side-effect of Non-treatment

Schizophrenia and Homelessness - Our demand for efficiency will turn the hardest hit into outcasts

Schizophrenia: Inner demons contribute to the homeless plight

The National Resource Center on Homelessness and Mental Illness

Gender differences in the relationship of homelessness to symptom severity, substance abuse, and neuroleptic noncompliance in schizophrenia (Pubmed research)

Solutions

Real Audio Recording: The Mental Illness System: How It Broke and How to Fix It
Speaker: Dr. E. Fuller Torrey, President, Treatment Advocacy Center, Bethesda, Maryland, September 2000. Don't have "Real Audio Player" - download a free copy from here.

Continuity of Care for the Homeless (text - Mentalwellness.com)

Recommended Book List - Schizophrenia in Society - Homelessness, Poverty, and other issues