Violence and Mental Illness: Connected?

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Violent incidents such as the mass killings in Newtown, Connecticut and at the Washington Navy Yard – two of the most recent on a long list of horrific acts – capture the nation’s attention and continue to raise alarms about the link between violence and mental illness.

A recent Gallup poll found that nearly half of Americans - 48 percent - blame the mental health system “a great deal” for mass shootings and for failing to identify individuals who are a danger to others.

Yet mental health experts aren’t so sure a link exists. “The link between mental illness and violence is really unclear,” says John Bradley, M.D. “What we really know is that people with mental illness are much more likely to be victims of violence rather than perpetrators.”

Dr. Bradley, who retired from the Unites States Army with the rank of Colonel and was previously Chief of Psychiatry at Walter Reed National Military Medical Center, appears as the principal guest on the December episode of Physician Focus with the Massachusetts Medical Society. He is joined by Michael Tang, D.O., M.P.H., a psychiatry resident at Harvard South Shore Psychiatry, a program of Harvard Medical School, to discuss a range of topics surrounding mental illness and violence. Hosting the program is John Fromson, M.D., Vice Chairman for Clinical Affairs of the Department of Psychiatry at Brigham and Women’s Hospital and Chief of Psychiatry at Brigham and Women’s Faulkner Hospital.

The idea that violence and mental illness are linked arises, in part, from the intense media coverage of sensational violent incidents such as the mass shootings. This has led to public perceptions that the perpetrator usually has a mental illness and that people with mental illness are prone to violence. Yet when one looks closely, the physicians say, some perpetrators are mentally ill, but many are not.

“The vast majority of violence that occurs happens outside the context of any mental illness,” says Dr. Bradley. “Violence is part of the human condition, and mental illness can play a role, but when you look at the statistics, it only plays a minor role.”

The mental health system hasn’t failed, Dr. Bradley says, noting that only one-third of those with a mental illness actually receive care. He believes part of the answer lies in education and understanding.

“We need to overcome the stigmas of mental illness and barriers to care,” he says. “What we really need is for people to understand that mental illnesses are brain diseases, just like diabetes or hypertension or a physical illness. They just happen to have emotional, behavioral, or functional impairments with them. The diseases are treatable, and the treatments are effective.”

Among the topics of conversation covered by the physicians are the definitions of violence and mental illness, predictors and risk factors for violent behavior, the pervasiveness of violence in daily life, the role and impact of the media in covering violent acts, the relationship of violence to firearm access, and whether the mental health system has failed in identifying individuals who may commit violent acts.

I invite you to join us this month on Physician Focus for a conversation on a subject that continues to make the news -- and shakes the nation’s conscience.

Photo: from left, John Fromson, M.D., John Bradley, M.D., Michael Tang, D.O., M.P.H.