Disability hate crime and targeted violence and hostility: A mental health and discrimination perspective

I remember the day they physically assaulted, myself and my sister, physically and verbally assaulted us and we had to call the police and it was just shocking to see grown people not only attacking you but encouraging their children to. I just lived in fear … its still going on … we've had rubbish just strewn all over our front garden … frogs posted through our letter box, graffiti, I came home to find they had urinated in the front door again (Brohan, 2010).

Discrimination is the behavioural enactment of prejudice (Thornicroft et al., 2007), and crime and harassment are increasingly becoming recognised as significant components of the discrimination faced by people with mental health problems. A survey in 27 countries showed that 26% of the 732 people with schizophrenia interviewed reported experiencing unfair treatment in their personal security which included verbal or physical abuse attributed to having a mental health diagnosis. Furthermore, 29% reported having been unfairly treated in their neighbourhood (Thornicroft et al., 2009). Two of the themes in a qualitative analysis from the international study above were Mocked and Abused and these appeared in relation to neighbours, friends, family, intimate partners, in the workplace and educational settings, on public transport and in the criminal justice and mental health system (Rose et al., in press).

It has long been known that people with mental health problems experience high levels of crime and harassment. Surveys by mental health charity MIND reported that 50% of respondents had experienced harassment in the workplace or community (Read & Baker, 1996) and 71% harassment, physical or sexual violence, theft or mistreatment (Mind, 2007). Sixty percent of people who use community mental health services have been victimised (Kelly & McKenna, 1997) and 41% harassed, compared to 15% in the general population control group (Berzins et al., 2003). Those with learning disabilities and mental health problems were those within the disabled group most likely to experience targeted violence and hostility (Sin et al., 2009). The most common perpetrators are teenagers and neighbours (Berzins et al., 2003; Sin et al., 2009), but they may also be strangers, colleagues, ‘friends’ partners or family members (Sin et al., 2009). Violence may also occur within the mental health system (Kumar et al., 2001). Experiences vary in level and type:

I did say to I think it was one of the inspector or whatever well “this train is overcrowded and I can't breath” then I heard a bloke saying ‘oh is the lunatic is asking about the overcrowding’. (Brohan, 2010)

I had dog mess pushed through my letterbox, closely followed by paint stripper thrown over the door causing a lot of damage (Thornicroft, 2006)

The gentleman came from upstairs, he came down and told me ‘you are mad, you are mental, that is why you are sweeping [the hall]’. And then he started beating me yeah … he kicks me. (Brohan, 2010)

A person's risk of violence or hostility is determined not only by their having a mental health problem, but also by other identities they hold such as ethnicity, gender, sexuality and physical disability (Mind, 2007; Sin et al., 2009).

Traditionally, violence and hostility experienced by people with mental health problems have been seen from a criminal justice or a welfarist perspective, but many now argue that this should be seen as a discrimination, equality and human rights issue (Sin et al., 2009). New laws reflect this view. The 1998 Human Rights Act guaranteed the right to ‘security of person’. In England and Wales, the Criminal Justice Act 2003 recognised disability hate crime together with homophobic and transgender hate crime, joining existing legislation on hate crime based on racism or religious hatred, and similar legislation was introduced in Scotland in 2008 (Sin et al., 2009). Hate crime is defined as any criminal offence which is perceived, by the victim or any other persons, to be motivated by hostility or prejudice based on a person's actual or perceived race, religion, sexual orientation, transgender or disability (Home Office, 2009). A hate incident is a non-crime that meets the same definition.

Section 146 of the Act imposes a duty on courts to increase sentences for any offence aggravated by hostility towards a victim's actual or perceived identity group. With hate crime the criminal justice system is also obliged to ensure the support needs of the person who experienced the crime are met. In 2006, the Disability Equality Duty placed a legal duty on all public sector bodies to promote disability equality, including the need to have due regard to eliminating unlawful harassment and victimisation (replaced in 2011 by a broader Equality Duty under the Equality Act 2010). In 2009, the UK ratified the United Nations Convention on the Rights of People with Disabilities. Article 16 gives disabled people the right of freedom from exploitation, violence and abuse (Equality and Human Rights Commission, 2010a). The concept of hate crime encompasses genocide and crimes against humanity. In the UK, the racist murder of Stephen Lawrence in 1993 and a series of homophobic murders acted as catalysts for action to counter these types of hate crimes. Concern about disability hate crime has been fuelled by the murders of Brent Martin and Steven Hoskin (Sin et al., 2009) and the case of Fiona Pilkington who took her own life and that of her daughter after a decade of disability-related harassment (Walker & Jones, 2009), and the death of David Askew who collapsed confronting youths who had been harassing him for 6 years (Tozer, 2011). A cross-governmental hate crime action plan was adopted in 2009 (Home Office, 2009), and in 2011 new approaches to tackling anti-social behaviour which aim to better identify and support disabled victims are being piloted in eight UK police forces (Home Office, 2011). The Equality and Human Rights Commission are conducting a formal inquiry into the steps taken by public authorities to prevent and eliminate disability-related harassment, and to address the causes of disability-related harassment including prejudice and negative attitudes (Equality and Human Rights Commission, 2011). Despite these developments, people with mental health problems have very low rates of reporting crimes directly to the police (Mind, 2007; Sin et al., 2009); when they report them to others such as health, social care or housing professionals these are often not reported on to the police, and when reported the criminal justice system sometimes does not investigate or drops unfairly the cases before they reach court (Mind, 2007; Sin et al., 2009). In one case in which a man with mental health problems reported that his ear had been partly bitten off the Crown Prosecution Service dropped the proceedings as he was viewed an unreliable witness. This prompted an appeal, supported by the Equality and Human Rights Commission, which led to a review and a High Court ruling that the decision to drop the case was irrational, unlawful and breached the Human Rights Act (Crown Prosecution Service, 2009). Despite progress, access to justice is seriously limited. When Radar sought nominations for its first ‘stop hate’ award in 2010, it identified numerous outstanding initiatives led by people with learning disabilities, but fewer initiatives led by people with mental health problems.

Many organisations such as Mind (2011), Radar (2011), and the UK Disabled People's Council (undated) strongly advocate hate crime approaches and support the setting up of third party reporting centres. In the UK, there is a national hate crime network, with strong Facebook activity specifically for disability (National Disability Hate Crime Network, 2011), as well as a national hate crime organisation covering all types of hate crime (Stop Hate UK, 2011). It is hoped that this hate crime framework will lead to greater reporting and access to justice and a reduction in the prevalence of hate crime. It also sends out a clear message that disability hate crime is to be taken as seriously as racist hate crime. Others have questioned its utility of the hate crime approach. For example, Sin et al. (2009) prefer the term ‘targeted violence and hostility’ and identify the language of hate crime as a barrier to reporting as it was felt to be confusing and did not reflect the significant, ongoing but low-level experiences of many people with mental health problems. A further language issue is that some people with mental health problems who meet legal criteria for disability may not consider themselves disabled and so may not feel that disability hate crime protections apply to them. Furthermore, hate crime terminology did not reflect the language used by the people with learning disabilities and mental health problems they interviewed, nor in fact the legal definition given earlier which requires a motivation of ‘prejudice or hostility’ rather than ‘hate’. The interviewees generally framed their experiences of violence and hostility in the language of discrimination, stigma and prejudice. They did not feel that the incidents were motivated by hate, but rather by either of them not being seen as a person or being viewed as a lesser person. People with mental health problems also felt that the violence or hostility was rooted in a fear of them engendered by stereotypes about dangerousness and unpredictability (Crisp et al., 2000) and biased media reporting (Clement & Foster, 2008). Another perceived motivation was perpetrators thinking that they could get away with it, a view compounded by the inaction of those who witnessed acts of violence or hostility or by the inaction that often followed when people told third parties about the incident. A further issue was that there was often an unbalanced power relation between the perpetrator and the victim. All of the above relate to discrimination and demonstrate its multifaceted centrality to this issue. Another issue was the actual or perceived vulnerability of the victim, making them an easy target, which may be compounded by isolation wrought by social discrimination. An additional perceived motivator was violence being a reaction to the victim's complaint about or retaliation regarding previous incidents, which further supports the need to find effective ways for providing redress. Research on perpetrators also attests that motivations are multiple and complex, with hate crime offenders often also being non-hate crimes offenders (Iganski et al., 2011).

Corrigan & Matthews (2003) list the risk of physical harm as a potential cost of disclosure of a mental illness, but state that this seems unlikely to occur. Interview data (Sin et al., 2009) indicates that harassment can be a direct result of disclosure, and lists non-disclosure as one of the consequences of targeted violence and hostility. Another important consequence is fear:

I do feel unsafe coming out of my flat, and going down the road and whatever. It's difficult to explain … I suppose it's fear of people, you know, shouting abuse. (Brohan, 2010)

As a consequence, people may restructure their lives, remaining in their homes, avoiding certain areas or moving house, which may bring relief but also frustration that it was they and not the perpetrator who had to move, and harassment may begin again in the new location (Berzins et al., 2003; Sin et al., 2009). Thus, targeted violence and hostility contribute to social exclusion:

I am really upset at people thinking I am violent … It is a really lonely feeling (Thornicroft, 2006)

Existing mental health problems can be aggravated by targeted violence and hostility:

The issue that I had with my next door neighbours, it really, really affected my mental health illness, it made me ill, I was hospitalised because of the extent of the stress it was causing me … I became so agoraphobic I refused to go out, and my sleep is so badly affected and disturbed. (Brohan, 2010)

Victims often seek to ignore the problem, either because they have been advised to do so, because targeted harassment or violence is seen as part of everyday life, or to minimise the risk of a repeat attack (Sin et al., 2009). This indicates the need for initiatives that send out the message that violence and hostility are not acceptable. Alternatively a person faced with a hate crime may react by taking action themselves, and this sometimes results in them being mistakenly seen as the perpetrator (Mind, 2007; Sin et al., 2009). Impacts may be wider than the individual, as families may be badly affected, and as others with mental health problems may witness targeted harassment and be fearful, restrict their lives and conceal their mental health identity to avoid being victimised themselves.

Only a minority of people with mental health problems who experience targeted violence or hostility report it to the police with main reasons for non-reporting being thinking they would not be believed or taken seriously; previous poor experiences with and lack of confidence in the criminal justice system (Scott et al., 2009); and lack of awareness of human rights (Berzins et al., 2003; Mind, 2007; Sin et al., 2009). Other reasons include feeling humiliated about being attacked, it being difficult or traumatic to verbalise what had happened, previous advice from others to ignore incidents, and issues of dependency and unequal power relations in the relationship between the perpetrator and victim (Sin et al., 2009).

Reporting to a third party such as mental health professional or housing staff is more common. As people sometimes find it difficult to bring up incidents themselves, routine enquiry by mental health professionals has been advocated (Walsh et al., 2003). Hate crime posters such as those produced on mental health-related hate crime by Stop Hate UK displayed in mental health settings may encourage direct and indirect reporting. Specific third party reporting centres are advocated and being set up (Stop Hate UK, 2011; UK Disabled People's Council, 2011). Health and social care professionals and the police sometimes see a report of an incident by a person with a mental health problem in terms of mental health need rather than only or also considering it as a need for access to justice. A further issue noted by Sin et al. (2009) is the stereotypes about the credibility of the accounts of people with mental health problems. This highlights the need for mental health awareness that specifically addresses these issues. Furthermore, mental health professionals need clear information about hate crime legislation and procedures, and about support organisations such as Stop Hate UK (2011) and Voice UK (2011) which support people with learning and mental health disabilities who have experienced a crime or abuse. The need for multiagency working, and a current ‘vacuum of responsibility’ have also been highlighted (Sin et al., 2009).

When people with mental problems are asked what would stop or prevent harassment, they suggested education in schools and community, change in public attitudes and more effective policing (Berzins et al., 2003). There is some evidence that anti-discrimination initiatives reduce service users' experiences of hearing others say offensive things about people who use mental health services (Schneider et al., 2011), although this study found no difference in reported experiences of being bullied, harassed or assaulted to due mental health. Similarly, England's Time to Change anti-discrimination programme has yet to find any significant change in service users' reported safety (Corker et al., 2010). Consequently, initiatives with components specifically focusing on targeted violence and hostility may be needed, perhaps akin to Stonewall's (2011) ‘Some people are gay – get over it’ anti-bullying campaign. Given that many incidents involve teenagers and neighbours, school- and local community-based initiatives might be most helpful. This might usefully link in with initiatives to tackle identity-based bullying in schools (Tippett et al., 2011). Hate crime posters (Stop Hate UK, 2011) may have a role to play not only in encouraging reporting, but also in sending out messages to potential perpetrators that targeted harassment is unacceptable. A recent consensus development study recommended the use of ‘see the person’ and human rights messages (Clement et al., 2010), the former fitting with the perceived motivations of perpetrators and the later with the framework proposed here. Another potential intervention is the use of direct and indirect social contact interventions that have components aiming to counter the dangerousness stereotypes (Clement et al., submitted), which may underlie some perpetrator behaviour.

Initiatives need to be evidence-based, therefore research is required to develop and evaluate the mental health service, access to justice and anti-discrimination initiatives described above. We need to discover whether a hate crime or a targeted violence and hostility framework is more effective, or a combination, using a range of terminology to demonstrate the spectrum from low-level taunts to full-blown hate-filled assault or murder. Further research on barriers and facilitators to access to justice is needed, at the level of the individual; third parties, including mental health staff; and in the criminal justice system. More evidence on the prevalence and predictors of targeted violence and hostility experienced by people with mental health problems is needed using representative samples. Although police forces are now required to record hate crime data and the British Crime survey will ask those who have been assaulted if they felt it was motivated by prejudice and if so against what group(s), these data are limited in scope and the latter excludes those living in supported and institutional settings (Sin et al., 2009). It is vital that such data be broken down by different disability experiences (including mental health problems as a distinct category) – rather than only recording ‘disability’ as though disabled people were a homogeneous group. Sin et al. (2009) have identified additional needs for research into cyber bullying; and on how targeted violence and hostility is nuanced by intersecting multiple identities relating to race, gender, sexuality, transgender, age and religion.

Declaration of interest:

LS and JP are employed by RADAR – the Disabled People's Network where JP is Public Affairs (Hate Crime) Officer. SC, EB and GT receive funding to conduct research on stigma and discrimination. This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1053). GT is also funded through a NIHR Specialist Mental Health Biomedical Research Centre at the Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.