Last of a three-part series
By William K. Alcorn
People with mental illness who receive good treatment are no more likely to be violent than the rest of the population, mental health professionals say.
In fact, those same professionals say people with mental illness are more likely to be victims than perpetrators.
But, according to scientific studies, people with untreated mental illness are more likely to be violent than people without mental illness, said Dr. Douglas A. Smith, clinical director of the Summit County Alcohol, Drug Addiction and Mental Health Services Board.
Therein lies the problem.
When deinstitutionalization began for people with mental illness, the goal was to decrease the use of state psychiatric hospitals and shift the saved funds into the community to create outpatient care and support services.
Unfortunately, not enough of the money saved went back to create more outpatient services, such as community mental health centers, said Dr. Smith, a psychiatrist.
“As a result, we have seen the shift of seriously mentally ill individuals out of the hospitals and into the streets as homeless and, equally concerning, into jails and prisons,” he said.
There have been some good studies on the relationship between mental illness and violence, Dr. Smith added.
The net result of the studies is that individuals with mental illness, with treatment, are no more likely to be violent than individuals without mental illness.
“This is the real message. If we, as a society, provide easy access to treatment, then mental illness will not needlessly lead to violence,” Dr. Smith said.
A 1990 study by Jeffery W. Swanson, professor in psychiatry and behavioral sciences at Duke University, delved into how serious mental illness contributes to overall violence.
Though 2 percent of individuals without mental illness or substance-abuse disorders are violent each year, that number jumps to 10 percent for individuals with active symptoms of untreated serious mental illness. Even more striking, individuals with marijuana-use disorders jump to 20 percent; individuals with alcohol-use disorders go even higher to 25 percent; and individuals with other substance use, such as opiates, cocaine, and methamphetamine, jump to 35 percent.
Still, Swanson concluded serious mental illness contributes very little to overall violence, representing just 4 percent of cases.
An important question is what proportion of people with mental illness are in treatment, said Dr. Mark R. Munetz, the Margaret Clark Morgan Foundation Endowed Chair in Psychiatry at Northeast Ohio Medical University in Rootstown.
For serious conditions such as schizophrenia, the estimates are that as many as 40 percent to 50 percent are not actively engaged in treatment. The dangerousness of people receiving treatment for mental illness is probably no greater than for the overall population. But the risk is increased for individuals who are not receiving treatment, Dr. Munetz said.
Mental illness is a spectrum of conditions that does not necessarily lead to any prediction of violence in a person, said Duane Piccirilli, Mahoning County Mental Health and Recovery Board executive director.
About 5 percent of homicides in the United States are committed by people with mental illness, while 90 percent of people with mental illness are never violent, said Kathleen Chaffee, executive director of the Columbiana County Mental Health and Recovery Services Board.
Of this small group of people with mental illness who are violent, some react to perceived or real threats or lose control of their emotions.
For example, a person may have delusions in which he believes people are going to harm him, and acts out violently to protect himself when he perceives threats, even when those threats are not real.
A person may have “command hallucinations” in which voices tell him to harm someone; or he may have very poor impulse control and react violently when he feels provoked or challenged, Chaffee said.
Others commit “predatory” violence, which is planned, she said.
People with anti-social personality disorder typically have no regard for right and wrong and disregard the rights and feelings of others. These individuals take advantage of others, and prey on others to get their own needs met.
People with mental illness who are young, male, abusing substances, with a history of violence, who are not receiving mental health treatment, or who are not complying with treatment recommendations are at the highest risk of committing violence, Chaffee said.
As referenced in the February 2015 American Journal of Public Health, “... little population-level evidence supports the notion that individuals diagnosed with mental illness are more likely than anyone else to commit gun crimes.”
Databases that track gun homicides, such as the National Center for Health Statistics, similarly show that fewer than 5 percent of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness, said April Caraway, director of the Trumbull County Mental Health Board.