Mental Health and Violence: Misconceptions Surrounding Mental Illness

By Kacey Heekin (2015)

Mental illness is a serious and prevalent condition in today’s society. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 18.5% of adults in the United States currently experience any mental illness and 4.2% experience serious mental illness (SAMHSA, 2014). Despite the prevalence of this condition, there remains much stigma and misinformation surrounding mental illness and mental health care.

One of the most harmful misconceptions about mental illness is the exaggerated association of mental illness with violence.

A Skewed Public Perception

The public perception of individuals with mental illness as dangerous is widespread and long-standing (Link et al., 1999, and Parcesepe and Cabassa, 2013). Results from a 2006 national survey indicate that a majority of people (60%) believe that individuals with schizophrenia are likely to be violent towards others and around a third (32%) believe that individuals with major depression are likely to be similarly violent (Pescosolido et al., 2010).

This opinion is troubling and is unsupported by reality; although mental illness may increase the risk of violence in some individuals, most individuals with mental illness are not violent. There is general consensus in the literature that a modest, yet significant relationship exists between severe mental illness and violence (Van Dorn et al., 2012). However, it is important to note that substance abuse has been indicated as a critical contributor to violence, especially in the presence of a concurrent mental disorder, and is responsible for much of the increased risk of violence in the population of individuals with mental illness. Furthermore, most violent acts are not committed by individuals with mental illness. Estimates specify that less than 3% to 5% of crimes in the U.S. are committed by individuals with mental illness (Metzl and MacLeish, 2015).

Individuals with mental illness are actually far more likely to be victims rather than perpetrators of violence. A study by Teplin et al., 2005, found that depending on the type of violent crime (e.g., rape/sexual assault, robbery, assault, etc.), individuals with severe mental illness were 6 to 23 times more likely than individuals in the general population to experience crime victimization.

The portrayal of individuals with mental illness as dangerous is very prominent in the entertainment industry and news media, adding to this overall problematic perception.

Everyone blames mental illness for mass shootings. But what if that’s wrong?

“… while I do think there’s a particular profile that many mass shooters fit into, the problem we get into when we diagnose the individual mass shooter and say mental illness is the cause is twofold. One, mental illness is really not causal for shootings; there’s no mental illness that causes people to shoot other people. Two, focusing on mental health takes the shooting out of context. If you look at recent mass shooters, whiteness, for example, is a theme that runs through many, many mass shooters, but we would never say whiteness is a cause of this. It shows we collapse and oversimplify the roles of mental illness in shootings, and mass shootings in particular.”

–Vox

The Negative Consequences of the Stigma of Mental Illness

The inaccurate beliefs about mental illness and violence have contributed to prevailing stigma. Fear and negative attitudes toward individuals with mental illness are common. The effects of stigma are substantial.

Stigma can prevent individuals with mental health issues from seeking a diagnosis and subsequent treatment. It can also cause individuals with existing mental disorders to have low self-esteem and to isolate themselves. Stigma is associated with inferior treatment outcomes (e.g., poor retention and adherence) and can thus be a major barrier to care.

The negative stereotypes of individuals with mental illness, especially those depicting these individuals as dangerous and violent, can limit educational, employment, and social opportunities.

Stigma can additionally cause the public at large and policymakers to pay less attention to mental health treatment issues/reform and can influence the current lack of sufficient mental health funding.

A Complex Array of Contributing Factors

There are many factors that affect violent behavior in both the general population and in individuals with mental illness. These factors tend to interact in complex ways, leaving much ambiguity as to the actual causes of violence.

Substance abuse, whether in the presence of a concurrent mental disorder or not, has a significant association with violence. A study by Fazel et al., 2009, found that individuals with schizophrenia and substance abuse comorbidity had a significantly increased risk of violence (27.6% had committed at least on violent offense), especially in comparison to the relatively small risk of violence among individuals with schizophrenia without comorbid substance abuse (only 8.5% had committed at least one violent offense). This study also discovered evidence from unaffected sibling data that suggests significant familial confounding of the association between schizophrenia and violence. These familial factors could include genetic or early environment contributors (e.g., poverty or exposure to violence).

Other factors that may contribute to violence among individuals with mental illness include personal stressors (e.g., divorce, death of a loved one, loss of a job, etc.) and socioeconomic status.

Understanding these factors and their interactions may aid in the assessment and prediction of violence among individuals with severe mental illness. Key elements to evaluate could include substance use, history of violence, age and gender, and socioeconomic condition. However, given the lack of violence by most individuals with mental illness and the complexity of the interactions between mental illness and these elements, preventing violence by means of identifying individuals with mental illness at increased risk of committing violent acts could be potentially unreliable at best and further damaging at worst.

The Truth about Gun Violence and Mental Illness

“The fact of the matter is that scapegoating those with mental illness after tragic instances of gun violence is not making us safer, nor is it promoting mental health. In being selective about what kinds of gun violence-or which victims deserve our concern, and choosy about when mental health issues warrant our attention, we merely pay lip service to tackling either. It’s wonderful to call for systemic reforms, to promote legislation, and prioritize mental health; but if political support is informed by stigma and conditionally granted, it helps noone.”

–Huffington Post

Change is Necessary

Overcoming the public misconceptions that individuals with mental illness are intrinsically violent and that most major acts of violence are committed by individuals with mental illness is critically important. Decreasing this ignorance could allow for the weakening of current stigma, the growth of compassion for persons with mental illness, and greater understanding of the need for policy changes and increased funding for services. The entertainment industry and news media are essential sources of influence on the public perception of mental illness and violence. These outlets could work to disseminate factual information on the relationship between mental illness and violence and to decrease the characterization of individuals with mental illness as inherently violent, dangerous, unstable, etc.

Reform of the mental health system is desperately needed, regardless of the potential effects on rates of violence. This system has been undermined by significant underfunding for quality mental health services. Access to treatment is inadequate for far too many individuals with mental health needs.

More research is needed on what causes violent behavior in general, and subsequent supportive legislation is necessary to improve public safety. The development of screening instruments to detect at-risk individuals and ensuing referral sources for necessary services could be particularly helpful. Preventative actions such as creating stricter gun laws could also be potentially valuable, as long as they are guided by reality and facts and not stigma and misconceptions.