Violence and Mental Illness? Other Risks Play Much Stronger Role

Although it’s a common public perception that people who commit violence are mentally ill, the research says otherwise, according to presenters at the panel discussion “Mental Illness and Violence — Toward Research-Informed Policies and Practice.”

“The next time some kind of violence occurs, instead of automatically focusing on serious mental illness as the possible cause, I urge you to ask what else is going on,” said Eric. B. Elbogen, PhD.

126831255While severe mental illness can be a cause of violent behavior, research shows that only 5 to 10 percent of violent crime is attributable to it. “Most people with severe mental illness do not commit violence toward others, and when they are violent, there may be stronger links to other risk factors,” said Elbogan, who is with the forensic psychiatry program and clinic at the University of North Carolina-Chapel Hill School of Medicine.

He noted findings of a national longitudinal survey of 34,653 people that looked at 16 risk factors for violence and found that the top five were age, sex, substance abuse, education and steady employment. Severe mental illness in the last 12 months was No. 14, while severe mental illness more than 12 months previously was No. 16. The survey was conducted in two waves: 2001 to 2002 and 2004 to 2005.

“We have to think beyond a psychiatric diagnosis and address protective factors, such as work, education, finances, self-determination, living stability, spirituality, family and social support,” he said.

Another national study of 1,399 veterans who served after 9/11 found that those who did not have protective factors had a 50 percent greater chance of engaging in severe violence than those who did have protective factors. “Instead of looking at PTSD or other mental illness as a cause for violent behavior, let’s look at if they are sleeping, if they are homeless, or if they are in physical pain,” he said.

There was a palpable sense of urgency in the standing-room-only crowd that heard a clear message that psychologists must be involved in the national policy discussion of gun violence prevention because of the direct impacts it has on their clinical practice and their clients.

“How violence is perceived is instrumental to policymaking,” said presenter Michael Awad, MA, who gave a preview of a study under way about perceptions of mental illness and violence among psychologists and legislators. “Consultation with the mental health profession in legislation has been largely absent.”

Thirty-three states and the District of Columbia have laws that restrict access to firearms by people who are mentally ill, and several states prohibit firearm purchase or possession by anyone who has been voluntarily admitted to a psychiatric facility within specified time periods, said Awad, a doctoral student at Columbia University.

In California, New York and Illinois, licensed psychotherapists must report clients who pose a serious threat of harm to themselves or others to local law enforcement. If a client does own a gun, the client’s firearm license may be suspended or revoked and the firearm must be surrendered, he said. “Gun owners are saying to other gun owners, ‘By no means should you seek mental health services,’” Awad said. “The fact is it’s much easier to get a gun in this country than to get mental health services.”

Robert T. Kinscherff, PhD, JD, who chaired the seven-member work group that developed APA’s Resolution on Firearm Violence Research and Prevention and helped write the APA report on Gun Violence: Prediction, Prevention and Policy said a public health approach based on research and that includes aspects of product safety and public education will be essential to successfully deal with gun violence.

 “There are in excess of 350 million firearms in the United States, more than the nation’s entire population,” Kinscherff said. “We discovered early on when writing the APA report that there is not a gun violence problem; there are gun violence problems with different impacts on different populations.”