Violence and Mental Illness

Brahna Wilczynski forwards some thoughts (below) about mental illness and violent behavior.  As context, recall that when Pres. Reagan was shot in an assassination attempt in 1981, the shooter, John Hinckley, was expeditiously placed in St. Elizabeth's where I believe he resides to this day. The more difficult problem is how to deal with the mentally ill who are judged to have a propensity to violence, but who have so far broken no law and committed no crime.  The vagaries of psychiatric diagnosis are well known, and civil liberties advocates stand ready to seek court orders to have institutionalized mental patients released where possible.

Yet, a passerby was stabbed to death a few years ago on Central Avenue in the entertainment heart of Albuquerque, near the historic Kimo Theater, by a discharged mental patient who was living on the street and off his meds. The shooter at Sandy Hook Elementary was considered strange by some who knew him -- but people have a right to be strange, and he apparently had done nothing that would have justified institutionalizing him or forcing him to undertake a regimen of anti-psychotic drugs.  What, exactly, could have been done differently, and under what authority? Not wishing to recapitulate anything resembling the Soviet mental health movement, we face a very sticky wicket here.

Byron

U.S. Congresswoman Gabby Gifford was shot less than two years ago in Tucson,  Arizona;  six others died.  Now, it’s an elementary school in Sandy Hook, Connecticut; twenty-five and six year-olds were shot to death. 

Once again the media rushes to link violence with mental illness.  The media seems to be reinforcing a common misunderstanding regarding mental illness and thereby further stigmatizing those afflicted with mental illness and their families.  In 2006, 60% of respondents in a national survey thought that all people with schizophrenia were likely to be violent.   This perception does not match up with some facts. 

     * A  study  in a Pittsburgh, Pennsylvania  neighborhood found that mentally ill people were not                                                                                         
       necessarily more violent than the general population. 

     * Lack of mental health care increases the risk of violent behavior.

     *Most people with schizophrenia who took anti-psychotic medication as prescribed were less
       likely to be violent than those who did not. 

     * Drug abuse is a more likely cause of violent behavior than mental illness.  However, people                 
        diagnosed with schizophrenia and drug abuse are 5 times more likely to be violent than 
        schizophrenics who do not abuse drugs. 

As we grieve and search for answers to these massacres by mentally ill people, we must struggle with this question:  In a democratic society, which is of greater value,  individual civil liberties or public safety?

Various approaches have been argued in public debate. That the mentally ill should not have access to firearms seems to be universally accepted, but it becomes more difficult after that.  One proposal would force a person with schizophrenia to take medication as an out-patient against his/her will.  Another is long-term commitment/hospitalization for any mentally ill person who has demonstrated a potential for violence.  

However the  question of individual liberty vs. public safety is resolved, it is clear that any strategy for prevention must be multi-pronged; and it must include improving our mental health services for both children and adults.