Easier Said Than Done Mental Illness & Violence

A Review of the Literature: Myths, Facts, Solutions & Implications for the Future

SAMHSA Internship Final PresentationJohn Arthur Jackson, III, B.A. Intern

CMHS Office of the DirectorApril 22, 2015

Introduction

Purpose

• SAMHSA has a rather critical role in producing an advancing the knowledge about the relationship between that of mental illness and violence. The evident volatility of this topic only affirms that we need to contribute to further dialogue

Causes of Attribution

– Availability heuristic • Undermining the prevalence and incidence

of those with mental illness committing crimes

– First Episode Psychosis • Risk of violence is higher during the first

episode of a disorder

– Social Exclusion– Ultimate Attribution Error

• fallacy of human judgment and schema to give an exaggerated disposition on one population or individual (mentally ill as having a proclivity to violence)

Method

• A systematic review of electronic bibliographic databases (e.g. CDC, NSDUH, APA, HHS and Google Scholar) utilizing the search: “LGBT”; “stigma”; “heteronormativity”; mental health”; “social determinants”; “shelters”; “Affordable Care Act”; “social exclusion”. Articles selected were full text, qualitative semi-structured interviews, cross-sectional assessment/research, systematic reviews and peer reviewed articles published between 2001-2014.

Previous Literature (cont.)

• Dr. Jonathan Metzl, Vanderbilt University–Mental illness and Gun violence

A Look At Previous Literature

• New York Times “A Misguided Focus on Mental Illness in Gun Control Debate– Dr. Jeffrey Swanson

– Violence predictors at the community level

Adam Lanza, 20 years old James Holmes, 25 years old

Seung-Hui Cho, 23 years old

Eric Harris & Dylan Klebold 19 years old

Results/Findings (cont.)

Gun violence is not due to mental illness.

• Certain mental illnesses make people less likely to commit violent acts– Schizophrenia can cause people to isolate or

withdraw from society – Most of the individuals experience First Episode

Psychosis • Largely attributed to violent behavior

Results/Findings (cont.)

• National Institute of Mental Health’s Epidemiologic Catchment Area study – (Swanson, Holze, Ganju & Jono) 2001–Mass killings are a rarity because people

w/ mental illness contribute so little to America’s overall level of violence.

– SAMHSA Mental Illness Violence Paper • Schizophrenic violence (0.3 percent) versus

that of the general pop. (0.02 percent) (Fazel, Gulati, Linsell, Geddes, and Grann, 2009)

3-5%

‘VICTIMS’

Implications for Future Research

• Intuitive to think that mass shootings is a proclivity of the mentally ill.

• Misuse/semantics/terminology/definition of mental illness

• *Antiquated models of addressing violence and mental illness

Implications (cont.)

• Implications: We should know that there is an ever present stigma associated with the mentally ill population. Compounded with the inevitability of an assumed violent proclivity displaces the rationality to a complete subjective ideology that has no substance.

Conclusion

• We can invest in structures and infrastructures that help make people less fearful of each other. Perhaps we could start by asking people why they think they need guns in the first place—and then addressing those underlying issues if and when we can.

• This of course is a double edged sword. Practitioners need to have the skill and the knowledge to address the appropriate issue at the appropriate time. This means an influx of evidence based programs targeted to mentally ill populations within a plethora of social institutions.

Recommendations

• SAMHSA Expert Panel• SAMHSA should review existing contracts,

grants and other programs and resulting inventory can be used to identify strengths, gaps and opportunities for SAMHSA to immerse themselves in an active discussion conducive to potential solutions concerning risk

• Programs to target First Episode Psychosis (since risk of violence is higher; supports need for early treatment to improve outcome of schizophrenia)

Conclusion (cont.)

• That might sound insane, or even a little ambitious—but to my mind, lost in the rancor is a deeper understanding of what guns mean to everyday people, and of why they feel they need them, or why they are against them. We’re losing out by not asking people these questions in a deeper way—whether guns are allowed, regulated or banned—as a way of creating a better conversation among reasonable people on all sides of the debate. Of course, we also need to strengthen mental-health delivery systems and community-health outreach networks so that people at risk can get help and support.

Conclusion (cont.)

• We can invest in structures and infrastructures that help make people less fearful of each other. Perhaps we could start by asking people why they think they need guns in the first place—and then addressing those underlying issues if and when we can.

• This of course is a double edged sword. Practitioners need to have the skill and the knowledge to address the appropriate issue at the appropriate time. This means an influx of evidence based programs targeted to mentally ill populations within a plethora of social institutions.

Questions ?

Thank You For Your Time!

SAMHSA Internship Final PresentationJohn Arthur Jackson, III, Intern to Deputy Director

CMHS Office of the DirectorApril 22, 2015