Leanne LegareDouglas CollegePsyc 3314Kristin WagnerFeb 20, 2013The Myths Behind the Mentally Ill and Levels of ViolenceThere is a general assumption, that because a person has been diagnosed with a mental disorder, they are more dangerous and more likely to commit a violent act than a person without a mental illness. In a national survey done in the United States, 75 percent of people reported that they viewed people living with a mental illness as dangerous and 65 percent of the people in the sample reported that they viewed people with Schizophrenia as being violent. (Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999) This assumption is perpetuated by the media on a regular basis the assumption is made often that a perpetrator of a crime being featured on the local news ” must have a mental illness, or must be crazy”. Advocates for the mentally ill and other professionals who work with the mentally ill have stated over and over that this thought process and belief is simply wrong. The mentally ill are often stigmatized, treated unfairly and labelled as violent or dangerous; out of people’s misconception and fear of the unknown or of those that appear different. Is there any evidence to support this misconception and to legitimize the public’s stance on it, or does the research evidence point in the opposite direction? This paper will look at the relationship between violent behavior and the mentally ill to see if there is in fact any evidence to support the thought that the mentally ill are more violent and dangerous as a whole then the general population. It will also examine whether certain mental illnesses are more prone to violence than others and what influences these particular misconceptions.
A multitude of studies have shown that the media and Hollywood play a huge role in helping to define the public’s thoughts and misconceptions about mental health and mental illness. On television or in movies, mentally ill people are quite often shown as being violent, scary, dangerous, and very unpredictable. News stories often dramatize the violent acts that have been committed by a mentally ill person and are usually shown as headline news; not often do you see clips or articles that highlight people with a mental illness recovering or show positive stories about people living with mental illness unless they are editorials or included in the back section of the newspaper. Movies often use very negative portrayals and use negative stereotypes about mental illnesses, to make their movies and shows more dramatic and entertaining. It is easy to understand how theses portrayals can be positively correlated to the public fears concerning the mentally ill. Not often do movie or televisions shows portray a mentally ill person making a recovery or becoming a productive member of their community, often they are only seen in a violent, negative light. Due to these negative portrayals, there are very significant consequences. Community members are more likely to condone things like forced treatment, less rules and regulation around civil commitment hearings, and rights of those with a serious mental illness if they are lumped together and all considered to be violent. This is currently being played out in the media right now with the new Act being pushed through trying to change the legislation around civil commitments. Stigma and discrimination are already problems for this group living in our community and often report that a large barrier to living a satisfying and happy life are being judged and , feared and treated unfairly, simply due to their disability.( )
Substance Use, Violence and Mental Health
The causes of violence in the mental health community are not as simple to define as people think but one major cause that has been reported in several studies is the serious lack of access to proper mental health services and support in their community. Lifetime prevalence shows that one third of people with a mental illness show evidence of comorbid substance use. (Regier, Farmer, & Rae, 1990). According to Monahan & Appelbaum’s (2000) research, a combination of substance abuse and mental illness have been correlated with violence. However, data indicates that those who have a affective disorders, substance use problems or personality disorders show a larger propensity for violence than those who are just diagnosed with schizophrenia (Monahan & Appelbaum, 2000)The one factor that remains constant throughout all the studies is that clients who do not receive the proper treatment in their community are more likely to be involved in violent activities. Those who have engaged in violence often then present with more complex clinical type problems which them often results in more violence. This is a huge reason why early psychosocial intervention and community treatment are so important for those living with mental illness. (Monahan & Appelbaum, 2000)In their study, (Van Dorn, Williams, et al, 2009) looked at a sample of 633 twenty one year olds to study the frequency of violence and substance abuse, mental illness and substance abuse and the use of multiple substances as well as the link between social determinants and the outcomes. About half of the same did not meet the criteria for a mental illness nor had a substance abuse problem. Out of the sample, 10. 6% reported that they had both mental illness and a substance abuse problem. Their research showed that while there were significant links found between being mentally ill, having a substance abuse problem and violence, it was not the most significant group. The group that has the most significant findings of violence was the group that did not have a mental illness but abused multiple substances. In fact, out of the three groups studied; mental illness/substance abuse, violence/substance abuse, multiple substances, the group with mental illness had the lowest significant findings in all areas except rebelliousness. When it came to risk factors, or triggers for their violent behaviors, the mental illness group was the group that had the most significant finding. The finding was that stressful life events often triggered the violence in them. This finding was significant to p <. 001 whereas for the other groups it was only p <. 1. (Van Dorn et al., 2009)Elbogen and Johnson (2009) found that people with severe mental illness were significantly (p <. 001) more likely to be violent if they had a past history of violence had experienced environmental stressors. Their research also found that people with a severe mental illness were more likely to have a history of violence than those living without a severe mental illness, but often as a participant, not the perpetrator. Their research also showed the clear significant link between substance abuse, mental illness and violence as well as the same link between severe mental illnesses and the violence versus the minor mental illness categories. This research did show that people with a serious mental illness, without substance abuse problems, have the same chance of being violent sometime in the next three years as any other person living in the community. (Elbogen & Johnson, 2009)
A prevalence study conducted by the Vancouver Police Department, over sixteen days, to see what the rate of contact with people exhibiting mental illness symptoms was showed that of the 1, 154 calls, police identified that 31% of all the people they came into contact with were displaying signs of poor mental health. Some of the calls accounted for in the study were for non-criminal activities. (Wilson-Bates, 2008) This survey was done using a form designed by police that asked the officers to rate the levels of disturbing behavior between one and seven. The study also indicated that severe mentally ill people did not have a larger number of serious crimes than did offenders without mental illness issues. When comparing the two groups for this data analysis, there was no significant differences in the samples demographic makeup, employment status, substance abuse or use, number of previous crimes, rate of arrest and the amount of time spent in police custody. (Sinha, 2009)Other studies completed in Canada have shown that police work involves contact with the mentally ill on a regular basis, but that the interactions are not always in the context of criminal activity and when it is criminal, they are not significantly different in the severity from contact with those accused people without a mental health illness. (Sinha, 2009) This same study showed that overall, people with a severe mental illness only accounted for less than one percent of those in contact with the police, but that three percent of police contact had to do with a person with a mental health issue.(Sinha, 2009) This discrepancy could have to do with the fact that people with mental illness are often more visible in the public and often calls are made to the police regarding people witnessing strange or disturbing behaviors or just simply because of the stigma and the assumption of violence related to being mentally ill. Correctional Service of Canada has collected the data and information on the mental health status of people who are incarcerated in the Federal system upon admission to their facilities. According to their report ” Corrections and Conditional Release Statistical Overview”, in the 2006/2007 year, approximately ten percent of all federally incarcerated persons had a diagnosis of a mental illness upon admission and that twenty one percent of federally incarcerated persons were using prescribed medications for a mental health related problem. (Sinha, 2009) The evidence overall shows that the number of prisoners in the federal system has increased dramatically since deinstitutionalization in the 1960s. This could point to a serious lack of treatment options in the community versus the correctional system. When researchers looked at and compared the rates of criminal activities among the mentally ill and those who are not mentally ill and incarcerated, currently in the federal system, it was found that both groups have about the same levels of criminal activity history, both inside the prison system and outside it. (Porporino & Motiuk, 2005) Again, this data shows that there is no predisposition to criminality or violence caused by diagnosis of a mental illness. Porporino and Motiuk also found that out of the two groups of offenders studied, 67% of those with a mental illness as compared to 64% of those without a mental illness were first time offenders. (Porporino & Motiuk, 2005)
In order for people living with a serious mental illness to live a satisfying life, it needs to be free from the stigma and discrimination. For all people living in the community, this is a key factor for the promotion of a more positive mental health status. Elbogen and Johnson (2009) offered several suggestion on how to reduce the risk for violence in the mentally ill population. Due to their findings that environmental stressors were often a cause of the violent acts they recommend that interventions to reduce the stressors be put into place. One of the significant risk factors that they identified was employment status on future propensity for violence. Interventions that could overcome this risk factor could include vocational training, supported employment service or other services to enable people with a mental illness to find suitable and stable employment. Therapy for the family or conflict negotiation between spouses may help to overcome the risk factor that divorces created. Elbogen and Johnson (2009) also recommend cognitive-behavior therapy to help reduce the anxiety related problems from the stress reactions which are typically a cause of physical abuse. Dual diagnosis treatment seems to be at the top of the list as this was a risk factor that came out in the majority of the studies. This is an area that appears to be lacking resources and that needs to be addressed.
The overall majority of people living with a form of mental defect or illnesses are not involved in criminal activities or violence. Due to the often complex suggestions and the significance of negative public ideas, a complex approach is needed to address violence and mental health, including addressing the root causes of violence, reducing stigma and discrimination, increasing the availability and access to mental health services, and utilizing a more sensitive approach by the media. Reducing the negative media portrayals of those with a mental illness is of paramount importance for changing the sensationalized perceptions about how dangerous, violent and unstable people with a mental illness are. Media and Hollywood can help to change this perception by showing the positive side of mental illness which will help to change negative opinions. The media can help by combatting misinformation, misperceptions and misconceptions with these positive stories of challenges overcome by people with mental illness. This will in turn help to reduce discrimination against and stigmas attached to having a mental illness.