How Can Psychologists Help Men and Boys?

463536557Five people were wounded overnight in shootings on Chicago’s West and South sides, according to a report in this morning’s Chicago Tribune. It’s a headline that appears almost daily in my city, and the victims, all men age 16 to 32, are among the most disadvantaged in the city – and frankly, in the country. Perhaps more importantly, this violence, and the stress and trauma that it leads to, is taking a serious toll on the health of men and boys in poor, urban communities throughout our nation, according to presenters at a symposium today.

At the session, members of APA’s working group on health disparities in boys and men discussed reasons why this population and other underserved groups of men have some of the worst health outcomes in the country.

Working group chair Wizdom Hammond, PhD, of the University of North Carolina at Chapel Hill pointed to several psychosocial factors that contribute to these health disparities, including a need among men to endorse and demonstrate traditional traits of masculinity, including toughness, self-reliance, confidence and aggression.

“It’s likely that the strains and conflicts associated with trying to live up to this masculine ideal is at least partly responsible for producing the kinds of health disadvantages we’re seeing,” Hammond said.

The researchers explained that, compared to women, males are more likely to take health behavioral risks, delay preventive health screenings and care-seeking for health problems, minimize their physical and mental health symptoms and signs of distress and have higher rates of substance abuse. These behaviors are even more widespread among men of low socioeconomic status, those who are ethnic and racial minorities, those who are gay or bisexual, and those who have been incarcerated.

Particularly when it comes to mental health, men and boys are socialized very early not to talk about their emotions around traumatic experiences, said presenter Waldo Johnson, PhD, of the University of Chicago.

“Therefore, they tend to suffer in silence,” he said.

The group is now finalizing an evidence-based report and a series of best practices and recommendations on the topic, for dissemination to psychologists and other health providers. One thing is clear, Johnson said:

“Any prevention or treatment program for this population must account for the unique circumstances of men and boys.”

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.”

Psychologists Weigh In On ‘Stand Your Ground’ Laws

“Stand your ground” laws have “little justification and demonstrably negative effects,” according to James M. Jones, PhD, a University of Delaware psychology professor and a member of an American Bar Association task force that is looking into the laws.

At the APA convention symposium “Stand Your Ground Law — Psychology’s Contribution to the National Conversation,” Jones and fellow speaker Jennifer Eberhardt, PhD, of Stanford University discussed the critical ways that psychological research can inform the fairness of these laws.

“The practical consequence is that these laws shift the presumption of innocence to the perpetrators and impose on the victim the burden of proving innocence,” said Jones.

465253133Twenty-five states now have “stand your ground laws,” which allow people who feel threatened to defend themselves without having to retreat, even if they are not in their own homes. The controversy around the laws escalated in 2012 when George Zimmerman shot and killed 17-year-old Trayvon Martin, who was unarmed and walking in their Florida neighborhood at night. Zimmerman was acquitted of second-degree murder.

“The Trayvon Martin case was such a profound jolt to our sensibilities, our sense of fairness and our trust in the judicial system,” said Jones. “We are fortunate that APA and psychologists can contribute to understand how it can occur.”

Jones reported that the ABA is now looking at the task force report, which explored such factors as how these laws may encourage violence and how they may create an imbalance between public and personal safety. ABA has authorized the task group to continue for another year and APA will continue its involvement with Jones as a member of the group.

Eberhardt discussed some of the research that has implications for “stand your ground” laws. For example, although research finds that most white people think that they treat other groups fairly and that discrimination is a thing of the past, her research tells a dramatically different story. In a series of studies, she has found that “race influences what we see, where we look and how we respond.”

Understanding the psychological consequences of these laws is critical, she said. “People of color are finding themselves in a vulnerable position in public spaces,” said Eberhardt. “Children of color are growing up situations where they feel  that the state is not protecting them, that the state does not recognize their pain. As children, they are already feeling invisible.”

How Do We Stem Gun Violence in America?

Copyright alptraum / 123RF Stock PhotoAmerican women are 11 times more likely to be murdered by someone using a gun than women in other democratic countries with developed economies, according to a presenter at convention panel today on gun violence prevention.

That statistic, revealed by Jacquelyn White, PhD, of the University of North Carolina at Greensboro, was one of several sobering facts discussed at the session, entitled “Gun Violence Prediction and Prevention – APA Policy Development, Dissemination and Implementation.” Some others: males constitute 90 percent of gun violence perpetrators and 70 percent of homicide victims. And there is a one in 144,000 chance that a person with schizophrenia will kill a stranger, according to Joel A. Dvoskin, PhD, of the University of Arizona College of Medicine.

“The myth is you have to be crazy to shoot a bunch of people,” Dvoskin said. “There is no evidence that people with serious mental illness are more likely to commit gun violence” than people without mental illness.

The common traits among people who commit gun violence are anger, depression, despair and social awkwardness, among others Dvoskin said. “In other words, profiles are stupid,” he said. “Profiles are stereotypes that blind us” to people who pose real risks.

The United States needs to take a science-based public health approach to stemming gun violence, treating guns like other dangerous products, said Robert Kinscherff, PhD, JD, of the Massachusetts School of Professional Psychology. This approach would take into account product design, safety features and improvements in how people store guns.

Finally, more research is required, said Gary D. Gottfredson, PhD, of the University of Maryland-College Park. “We don’t know an awful lot,” he said. “We lack a national system for uniformly collecting information about firearms violence. … That has to end.”