"60 Minutes" Focuses on Schizophrenia and Violence

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Untreated mental illness an imminent danger?

Psychiatric News Alert: "60 Minutes" Focuses on Schizophrenia and Violence

American Psychiatric Association

Treatment Advocacy Center

Understanding Severe Mental Illness

A January 11th posting by the National Institute of Mental Health:

By Thomas Insel (pictured)

When a tragedy occurs like the shooting in Tucson this past weekend, all of us seek an explanation. While there remain many questions, a leading hypothesis is that the suspect has a serious mental illness (SMI), such as schizophrenia. The topic of violence and mental illness is never an easy discussion: with issues such as stigma, incarceration, public safety, and involuntary treatment in the mix. There is a legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood that people with serious illness will be further marginalized and less likely to receive appropriate care. But tragic events, whether at a Safeway in Tucson or a classroom at Virginia Tech, require us to address this uncomfortable subject with the science available.

Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further (1). But, mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. Teplin et al found that those with SMI are 11 times more likely to be victims of violent crime than the general population (2).

The most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, the most recent year for which we have statistics, there were almost 35,000 suicides, nearly twice the rate of homicides. Suicide is the 10th leading cause of death in the United States (3). Although it is not possible to know what prompted every suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit.

Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others. Research has suggested that those with schizophrenia whose psychotic symptoms are controlled are no more violent than those without SMI (4). It’s likely that treatment not only helps ease the symptoms of mental illness, but also curbs the potential for violence as well.

As we learn more about the circumstances surrounding the tragedy in Tucson, we should be working harder to ensure people with SMI receive the care they need. Early intervention offers the best hope to prevent more tragedies in the future.

For more information on SMI and other mental health statistics, please visit NIMH’s Statistics page.


References

1. Swanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.


2. Teplin et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry. 2005 Aug. 62. 911-921.


3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/ncipc/wisqars.


4. Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55:393-401.

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Mental illness alone no trigger for violence

An article published in the February 7th edition of The Chronicle Herald:

By Carla K. Johnson, The Associated Press

CHICAGO — A new large study challenges the idea that mental illness alone is a leading cause of violence.

Researchers instead blame a combination of factors, specifi­cally substance abuse and a his­tory of violent acts, that drives up the danger when combined with mental illness in what they call an “intricate link."

People with serious mental ill­ness, without other big risk fac­tors, are no more violent than most people, according to the study of more than 34,000 U.S. adults.

“Mental illness can provide the knee-jerk explanation for the Virginia Tech shootings," but it’s not a strong predictor of violence by itself, said author Eric Elbo­gen [pictured] of the University of North Carolina at Chapel Hill School of Medicine.

Elbogen compiled a “top 10" list of things that predict violent behaviour, based on the analysis. Younger age topped the list. History of violence came next, followed by male gender, history of juvenile detention, divorce or separation in the past year, histo­ry of physical abuse, parental criminal history and unemploy­ment in the past year. Rounding out the list were severe mental illness with substance abuse and being a crime victim in the past year.

After the 2007 Virginia Tech killings by a student ordered to get psychiatric treatment, some states considered laws adding mental health questions to back­ground checks for gun buyers or denying weapons to people who’ve been involuntarily com­mitted for mental health treat­ment.

The new research, which bol­sters other similar findings, rais­es questions about such laws, ex­perts said. Such legislation may be both ineffective and discour­age people who need help from getting treatment.“We are being misled by our own fears," said Columbia Uni­versity psychiatry professor Dr. Paul Appelbaum, who wasn’t in­volved in the new study. “We ought to be concerned about pro­viding good treatment and help­ing people lead fulfilling lives, not obsessed with protecting ourselves from phantom threats that appear to be unrelated to mental illness."

U.S. systems to treat mental ill­ness and substance abuse are separate, uncoordinated and could do a better job treating peo­ple with both problems, Appel­baum said.

Also see:

The Intricate Link Between Violence and Mental Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Photograph of Eric Elbo­gen courtesy of the University of North Carolina at Chapel Hill School of Medicine.

Major Problem Often Overlooked When Linking Violence, Illness

To read this article written by Mark Moran and published in the February 1st issue of Psychiatric News, click here.

Violence and Mental Illness — How Strong Is the Link?

Dr. Richard A. Friedman concluded the following in a recent article published by the New England Journal of Medicine:

"The challenge for medical practitioners is to remain aware that some of their psychiatric patients do in fact pose a small risk of violence, while not losing sight of the larger perspective — that most people who are violent are not mentally ill, and most people who are mentally ill are not violent."

He also noted:

"A study that compared the prevalence of violence in a group of psychiatric patients during the year after hospital discharge with the rate in the community in which the patients lived showed no difference in the risk of violence between treated patients and people without a psychiatric disorder. Thus, symptoms of psychiatric illness, rather than the diagnosis itself, appear to confer the risk of violent behavior."

An interview with Dr. Friedman can be heard by clicking here.

Schizophrenia and Violence

Click here to read this posting from Tony's Schizophrenia Corner.

Photograph of Tony taken from Tony's Schizophrenia Corner.