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Mental illness & violence: Look behind the anecdotes

Post by Patrick O'Callahan on April 23, 2012 at 6:13 pm |
April 23, 2012 6:42 pm

Mental illnesses can be scary – think of the screaming meltdown an American Airlines flight suffered last month. The bizarre behavior of some people with severe psychiatric disorders has amplified public perceptions that they are dangerous.

This narrative got another boost Friday when a one psychiatric patient at Western State Hospital killed another, reportedly by jamming a pen or pencil into his ear. In response, the Department of Social and Health Services released the following fact sheet:

Fact 1: The vast majority of people with mental illness are not violent.

Here is what researchers say about the link between mental illness and violence:

- “Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population (Institute of Medicine, 2006).”

- “…the vast majority of people who are violent do not suffer from mental illnesses (American Psychiatric Association, 1994).”

- “The absolute risk of violence among the mentally ill as a group is very small. . . only a small proportion of the violence in our society can be attributed to persons who are mentally ill (Mulvey, 1994).”

-”People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et al., 2001). People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population (Hiday, et al.,1999).”

Fact 2: The public is misinformed about the link between mental illness and violence.

A longitudinal study of American’s attitudes on mental health between 1950 and 1996 found, “the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled.” Also, the vast majority of Americans believe that persons with mental illnesses pose a threat for violence towards others and themselves (Pescosolido, et al., 1996, Pescosolido et al., 1999).

Fact 3: Inaccurate beliefs about mental illness and violence lead to widespread stigma and discrimination:

The discrimination and stigma associated with mental illnesses stem in part, from the link between mental illness and violence in the minds of the general public (DHHS, 1999, Corrigan, et al., 2002).

The effects of stigma and discrimination are profound. The President’s New Freedom Commission on Mental Health found that, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders – especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment (New Freedom Commission, 2003).”

Fact 4: The link between mental illness and violence is promoted by the entertainment and news media.

“Characters in prime time television portrayed as having a mental illness are depicted as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence” (Mental Health American, 1999).

“Most news accounts portray people with mental illness as dangerous” (Wahl, 1995).

“The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses” (Wahl, et al., 2002).

Citations
American Psychiatric Association. (1994). Fact Sheet: Violence and Mental Illness. Washington, DC: American Psychiatric Association.

Appleby, L., Mortensen, P. B., Dunn, G., & Hiroeh, U. (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet, 358, 2110-2112.

Corrigan, P.W., Rowan, D., Green, A., et al. (2002) .Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28, 293-309.

DHHS. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. http://www.surgeongeneral.gov/library/mentalhealth/toc.html

Hiday, V. A. (2006). Putting Community Risk in Perspective: a Look at Correlations, Causes and Controls. International Journal of Law and Psychiatry, 29, 316-331.
Institute of Medicine, Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: Institute of Medicine, 2006.

Mental Health America. American Opinions on Mental Health Issues. Alexandria: NMHA, 1999.

Mulvey, E. P. (1994). Assessing the evidence of a link between mental illness and violence. Hospital and Community Psychiatry, 45, 663-668.

Pescosolido, B.A., Martin, J.K., Link, B.G., et al. Americans’ Views of Mental Health and Illness at Century’s End: Continuity and Change. Public Report on the MacArthur Mental health Module, 1996General Social Survey. Bloomington: Indiana Consortium for Mental Health Services Research and
Joseph P. Mailman School of Public Health, Columbia University, 2000. Available: http://www.
indiana.edu/~icmhsr/amerview1.pdf

Pescosolido, B.A., Monahan, J. Link, B.G. Stueve, A., & Kikuzawa, S. (1999). The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health, 89, 1339-1345.

New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.

Wahl, O. (1995). Media Madness: Public Images of Mental Illness. New Brunswick, NJ: Rutgers University Press.

Wahl, O.F., et al. (2002). Newspaper coverage of mental illness: is it changing? Psychiatric Rehabilitation Skills, 6, 9-31.

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