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On mental health and violence

Social Work Professor King Davis offers a historical perspective on the publicly held assumption that mental illness is always linked with violence.

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Photo of King Davis

Dr. King Davis, a professor in the School of Social Work. Photo: Tanya Hartman

Dr. King Davis, the Robert Lee Sutherland Endowed Chair in Mental Health and Social Policy in the School of Social Work, served as executive director of the Hogg Foundation for Mental Health from 2003-2008. His current funded research focuses on the history of mental health services and policies for African American populations.

An editorial in the Williamsburg Virginia Gazette in the 1760s commented briefly on the murder of an elderly woman by the son of one of her neighbors. The editorial writer described the young man as a lunatic and called on the Virginia legislature to protect the public from any future violence by building and maintaining asylums. The legislature created America’s first lunatic asylum at Williamsburg in 1775. The editorial also helped reinforce the publicly held assumption that mental illness is always associated with unpredictable danger and violence. This 18th century editorial has come to mind numerous times since the recent shootings in Arizona.

A decision will be made soon whether Jared Loughner will share a severe mental illness diagnosis with Charles Whitman, John Hinckley Jr. and Seung-Hui Cho or the label of nihilist with the Oklahoma City bomber. As with these earlier episodes, the public reaction is understandably mixed. Throughout the nation, the personal expression of support and grief has been spiritually eloquent; and the incident served to bring Americans together as in 2001, albeit briefly. The other responses have been anger, confusion and a desire for retribution. The assailant has been described as a lunatic with calls for the death sentence, life without parole, or placement in a mental hospital. Gov. Jan Brewer of Arizona has issued a statement expressing her remorse. She understands these complicated issues from the standpoint of a parent of a severely mentally ill child. Her son was diagnosed with schizophrenia over 20 years ago and has lived in a state mental hospital after a not-guilty by reason of insanity defense. However, Brewer has been forced to cut state funding for mental health services.

Most mental health professionals have reserved their judgment on whether Loughner is or is not severely mentally ill. These reservations may change as a detailed history develops, more observations are made, and a thorough forensic exam is completed. Most, however, are clear about the complexity of predicting violence and eschew the public assumption that historically connected it to mental illness. The mentally ill are usually not as violent as the rest of the population.

There are other facts that we know about mental illness to consider. Mental illness is ubiquitous throughout the world. Fully 25 percent of the U.S. population has a diagnosable mental illness at any given time; but, only 5-10 percent requires intense professional care, according to the article “Twelve Month Use of Mental Health Services” in the Archives of General Psychiatry, a professional medical journal and a report by the Department of Health and Human Services. However, the majority of individuals with mental illnesses does not seek or accept help unless required by a court. Regrettably, unrecognized and untreated mental illness is common in the United States leading to major losses in productivity, absenteeism, academic achievement or healthy relationships. Families remain the primary caregivers and their lives, too, tend to reflect the emotional status of their loved ones. Since 2001, admissions to state mental hospitals have increased by 21 percent, reversing a 50-year decline, according to a 2009 article, “Changing Trends in State Psychiatric Hospital Use,” that briefly gave support to the idea that advancements in mental health sciences might result in their permanent closure.

We also know that persons with severe mental illness tend to die 25 years earlier than others of the same age. Of these deaths, the majority are from preventable medical causes that have gone unrecognized and poorly treated. But up to 40 percent of these early deaths are from suicide. Admittedly, some individuals with mental illness may resort to violence when they believe that someone has done them harm as appears to have been the case at Virginia Tech. In addition, the person may expect to die in the commission of a crime almost as a martyr or as punishment. In his writing, Loughner appears to have predicted and planned his own death.

So what are we to conclude? Mental illness is sometimes difficult to identify and sometimes even more difficult to treat or prevent. Predicting when or if violence will occur is more difficult. Clearly, little can be done where the illness is neither recognized or when professional help is not sought, rejected or unavailable. It is not clear whether Jared Loughner sought or used mental health care. However, we must not repeat the 18th century policy of locking people away in institutions. Rather, we must increase our understanding that mental illness is a brain disease that responds well to some interventions. We must increase public understanding of these illnesses and the value of seeking and using early treatment and the new services in the community and the campus geared towards integrated care and recovery.