Massachusetts Medical Society's Physician Focus

Violence and Mental Illness

PROGRAM HIGHLIGHTS:

  • 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.

  • People with mental illness are more likely to be victims of violence rather than perpetrators of violence.

  • The greatest predictor of violent behavior is a past history of violent behavior, regardless of the presence of mental illness.

  • More than half of violent acts occur within the context of the family or a household setting.

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The killings in Aurora, Colorado and Newtown, Connecticut in 2012 and at the Washington Navy Yard in 2013 are but three of the most violent in a long list of mass shootings in the United States that have shocked the nation. Violent incidents like these continue to raise alarms about the link between violence and mental illness.

Such events have created strong public perceptions that violence and mental illness are linked and that one can lead to the other. Mental health experts, however, are not so certain.

“The link between mental illness and violence is really unclear,” says John Bradley, M.D., Chief of Psychiatry and Deputy Director of Mental Health for the Veterans Administration Boston Healthcare System. “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.”

Mental health experts say that the single greatest predictor for violent behavior is a past history of violent behavior. Other risk factors include being raised in an environment of violence, being abused as a child, abuse of drugs and alcohol, and having access to firearms.

The facts are that more than half of violent acts, including homicides, occur within a family or household settings where people are known to one another. Research also shows that violence occurs more often in lower socio-economic areas, and that people who engage in violent behavior are more likely to have been abused as a child.

To the question of whether the mental health system has “failed,” Dr. Bradley firmly responds ‘no,’ noting that only one-third of people with a mental illness actually receive care. He believes a greater understanding of mental illness is needed, more treatment is required, and that greater attention must be paid to the issue of access to firearms by people with a mental illness to the question of whether the mental health system has “failed,” Dr. Bradley firmly responds ‘no,’ noting that only one-third of people with a mental illness actually receive care. He believes a greater understanding of mental illness is needed, more treatment is required, and that greater attention must be paid to the issue of access to firearms by people with a mental illness.

“We need to overcome the stigmas of mental illness and barriers to care. 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.”

Watch the accompanying video for the complete discussion, including conversation about the definitions of violence and mental illness, the pervasiveness of violence in daily life; the role and impact of the media in covering violent acts; and the relationship of violence to firearm access.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
National Alliance on Mental Illness

National Institute of Mental Health

American Psychiatric Association

National Center for Domestic Violence, Trauma, and Mental Health


From left, John Fromson, M.D., John Bradley, M.D., Michael Tang, D.O., M.P.H.
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