Experiences of violence among people with severe mental illness: social, biographical and institutional factors (EVIO). A study protocol for a mixed-methods study.

Background: People with severe mental illness (SMI) face a significantly higher risk of victimization than the general population. Beyond physical harm, such experiences can severely impact mental health and recovery processes. Empirical research on violence prevalence among people with SMI in Germany is limited, with little understanding of mechanisms, the impact of gender, and the victim-perpetrator overlap. In order to develop successful prevention strategies against victimization, a comprehensive understanding of the complex phenomenon of victimization is needed. The study aims to develop a comprehensive understanding of the biographical, socio-cultural and institutional context factors related to experiences of violence, as well as to identify barriers to addressing such experiences within mental health settings. Methods: In a mixed-method study incorporating a quantitative survey and qualitative instruments, we investigate the prevalence of violence, including both victimization and perpetration, among people with SMI. Our study includes the following: (1) In a sample (n=500) of people with SMI, treated in inpatient and outpatient mental health settings, we will investigate the prevalence of victimization and violent behavior, (self-)stigmatization, and barriers for disclosure of experiences of violence within mental health settings. Data will be obtained from samples at seven psychiatric hospitals with mandatory care on a fixed day. For comparisons with the general population, we use an online sample (n=1000). (2) Based on this, we conduct qualitative interviews with a subsample of people with SMI (n=30) who reported experiences of violence. Using biographic-narrative interviews, we focus on the biographical and socio-cultural context (3). In addition, we use qualitative and quantitative measures to investigate mental health professionals' experiences, institutional factors, and strategies to deal with mental health service users' violence experiences. Discussion: Developing interventions to prevent and reduce victimization requires a systematic assessment of mental health service users' violence experiences and a comprehensive understanding of the biographical, socio-cultural, and institutional factors. Our study aims to contribute fundamentally to a deeper understanding of violence experiences in Germany, thereby providing the basis for the development of targeted interventions to improve the awareness and the handling of violence experiences among a specific vulnerable group. Trial registration: This study is registered in the German Clinical Trial Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00032041 (Date of registration July 2023).