Article Review: Raising Cain: The Problem of Family Homicides

This is not a pleasant topic for Christmas time, but this is a report on an article in Psychiatric Times, by E. Fuller Torrey, MD, August 2016.  This is the first study of the prevalence of family homicides in the families of the mentally ill.  Of the more than 16,000 homicides in the U.S. in 2013, 4000 were within the same family.  Of those within the same family, most were spouse on spouse, which are not attributed to the mentally ill.  However, the majority of child on parent and parent on child homicides are.  In calculating the total, this study estimates that the mentally ill are responsible for about 29 percent of the family homicides, or 1150.  The weapon used was guns and sharp objects and beatings (each however in less than a third of the cases.)  It appears the elderly are vulnerable to family homicide by mentally ill, in light of the mentally ill more often living at home rather than in the hospital.  Two issues play a major roll,  Not taking medications is associated with increased homicides, as is co-occurring substance abuse, particularly alcohol.  Persons with mental illness account for over seven percent of the total homicides in the U.S., over 1000 annually.  Suggestions to reduce this number are:
Adequate psychiatric care.  Clozapine is shown to reduce aggression, but under utilized in the U.S.
Assuring medications are being taken.  A switch to injectables is likely to help in this area.
Assisted Outpatient Treatment (AOT in which the recipient in which an individual is required to follow his prescribed plan to live in the community has shown a reduction in violent, threatening and aggressive behavior.
Reform of HIPAA requirements which keep vital information from family members.
Focus on individuals with the most need.  Prior warnings are usually given before homicides which include threats of harm and assaultiveness.  Interpretation of laws regarding involuntary psychiatric hospitalization and treatment for these threats should not be interpreted narrowly.
Improved data collection to further study this problem would give a better idea of the prevalence.  This would lead to better tools for assessing possible problems.
The author lastly claims that mental health stigma is incumbent on violent acts.  This is because of media perception in the newspapers.  Only by reducing these violent acts will stigma decrease.