Mental Illness and Violence
Many people in society associate mental illness with violence, assuming there is a direct link. I intend to challenge that public perception in this article and hopefully trigger a change in attitudes.
The fact is that anyone can be a risk to themselves or others — not only "the mentally ill" — and the majority of people with mental illness are NOT violent.
Consider these facts from the USA and UK:
- People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. (Abbleby et al, 2001)
- People with mental health problems are more dangerous to themselves than they are to others: 90% of people who die through suicide in the UK are experiencing mental distress. (TimeToChange.org)
- Schizophrenia and bipolar are the two serious mental illnesses associated with violent behaviour. However, the vast majority of people with mental illness are not violent and never will be. (Jan Volavka, Violence in Schizophrenia and Bipolar Disorder, 2012)
- According to new research published by the American Psychological Association, only 7.5% of crimes committed by people with serious mental disorders were directly related to the symptoms of those mental disorders. (Jillian Peterson, The American Psychological Association)
- 95-97% of gun violence is NOT caused by a mental illness. (Swanson, J.W., McGinty, E.E., et al. 1990 NIMH study)
Interestingly, an international survey was conducted by J. Reid Meloy (a psychiatrist at the University of California) taking a sample of 27 mass murders that took place between 1958 and 1999. It was found that the perpetrators, all of whom were adolescent men, were likely to be loners as well as users of drugs and/or alcohol, with close to half being bullied in the past and close to half with a history of violence.
Twenty-three percent also had a history of mental illness, but only two of them were experiencing psychotic symptoms at the time. She said, “When you accounted for the other factors, mental illness added little predictive value."
Let’s think about these facts. I have a diagnosis of bipolar and these figures have had a real impact on me. I should imagine they have an even bigger impact on those not living with a mental illness who fall prey to the stigma that still floods people's minds.
In relation to violence it’s a tough job to change people’s minds. There is an evidential shift in attitudes towards accepting mental health problems, but it seems difficulty lies in the acceptance that mental health is not directly linked to violence.
Why Do So Many People Think This Way?
The media has a lot to answer for. We are influenced by the information available to us and this makes up our belief system. When those beliefs are continually reinforced they set like cement and it takes time to break them down. We could refer to the media metaphorically as "the cement mixer," which has stirred the misinformation and spread it around, breeding stigma and discrimination.
Jeffrey Swanson, a medical sociologist and professor of psychiatry at Duke University made it his life pursuit to investigate the connection between mental illness and violence because he recognized the public perception but couldn’t find good data evidence to support the connection. He said:
“As recently as 2013, almost 46% of respondents to a national survey said that people with mental illness were more dangerous than other people."
Wow, that’s almost half of the population thinking people like myself are dangerous, even though the facts say different!
TV and Films
I watched a thriller film about a year ago on a group of teenagers who went on a trip to what appeared to be a haunted house. People started to disappear and it became a guessing game as to who was the dangerous culprit.
Guess what — the guy luring the others away with the intent to murder had a diagnosis of schizophrenia. Everyone was petrified of him and the film ended in a chase and stabbing frenzy. Why on earth it was necessary to link the murderer’s crime to a diagnosis of schizophrenia?
Newspaper Headlines
Paranoid schizophrenia is a diagnosis that battles with labelling stigma. This headline was taken from the Daily Mail newspaper back in 2011: “Schizophrenic stabbed little brother, nine, to death hours after health workers said he was no threat."
Schizophrenic! I guess that defines him then. (Sorry, my sarcasm expresses my annoyance.) Would we start this headline with “diabetic," “cancer sufferer," or, “amputee?" No, I don’t think so.
Sensationalism
Sensationalism is considered necessary to sell films, TV dramas, newspapers and magazines, but how many holes could we pick at them? Looking at the headline just mentioned we know little about circumstances. Was there a trigger? If health workers said he was no threat, can the crime be directly linked to his diagnosis? If he was in crisis, what about the role of his health worker and his compliance with treatment? Were alcohol or substances involved?
We may be given more facts in the article but the headline's connection between mental illness and violence is misleading. Most reporters have limited mental health knowledge in terms of understanding the impact of negative reporting and stigmatizing language. They are not specialists and their damage can be colossal. There are guidelines to adhere to where mental health specialists should be consulted, but in my opinion these are not enforced nearly enough.
Consider My Story
I have a diagnosis of bipolar and yes, unfortunately, I have been violent.
I’ve always had a hot temper but the majority of time it has been manageable. In my early 20s I battled depression, and the contraceptive pill gave me terrible mood swings. I struggled to control my frustration one day and I hit my boyfriend. I was devastated.
When I was diagnosed with bipolar at the age of 26 the only person at risk of violence was myself. I would never, ever want to harm someone so when the agitation and fear peaked or I was in the depth of distress and hit rock bottom I would self-harm.
However, one day I was in the middle of a mixed manic episode. I was impulsive, agitated, irritable, withdrawn and terrified of everything. I had reported my symptoms as an inpatient in a general hospital but no one would listen to me and no one would refer me to a psychiatrist. My diagnosis was known to them, yet they kept labelling me "anxious." I was therefore not receiving adequate treatment.
I had been to the pub with my dad and drank half a bottle of wine. I was impulsively drinking after being abstinent for months, desperate to dampen my manic symptoms. My dad had also been drinking and he made a very upsetting comment, to which I responded with verbal abuse before running home crying.
I couldn’t cope with my feelings and perceived everything to be a trigger. I rang a helpline extremely distressed. I continued to drink and called my dad to tell him how upset I was. He didn’t answer the phone. I waited up for hours to speak to him. It was some time before I realized he had snuck in and was asleep in bed.
I went and asked him why he’d said such an awful thing and he shouted obscenities at me. I lost my temper and I hit him. As a result my mum threatened to call the police, and I actually told her she should. I was terrified for myself; I felt out of control and I desperately wanted to feel safe.
It was difficult the next day. I felt as though everyone was blaming my illness and thinking things like, "She’s lost it." I knew I was in the wrong and I knew I was in the worst state of agitated, irritable mania possible, but I still felt gutted at the comment that triggered it all. I was confused about what was a relatively normal reaction to the situation and what was the result of my illness.
Was This a Symptom of My Bipolar?
So let’s review the situation: I had been violent before with no diagnosis. On this occasion I did have my diagnosis of bipolar and had reported mixed state symptoms, but had been ignored and no treatment was given.
I had symptoms of agitation, irritability and I was self-harming. I was distressed, terrified and highly anxious. I was using alcohol to cope and had been drinking, as had my dad. There was a trigger, which I believe anyone — with or without a mental health diagnosis — would have been upset and aggravated by, though this of course does not excuse violence.
I believe my risk of violence was increased due the professionals I went to not listening to my concerns, as well as the use of alcohol — but I think it is impossible to say I was violent as a symptom of my bipolar.
Afterwards I asked myself this: “If I didn’t have bipolar and I heard that comment said to me, would I lose my temper in some way?" Unfortunately, my automatic response was “yes." There were many variables to consider.
Can any of us say guarantee that we are at no risk of losing our temper? Can't most of us relate to a time where we just couldn’t handle a situation and reacted out of character?
What Are the Risk Factors?
Absolutely anyone can be at risk of being violent, whether they have mental health problems or not. Some of the factors include being in unstable relationships, unemployment, exposure to violence or abuse at an early age, previous violence, alcohol and substance misuse, and gender — men are more likely to commit violent crimes than women).
In fact, any of life’s stressful events and ongoing life problems can put a person a risk.
For those experiencing mental health problems, the highest level of risk occurs when that person is misusing drugs and/or alcohol, not undergoing or complying with treatment and is experiencing psychosis or delusions.
If You Are Worried You May Hurt Someone Else
Take immediate action. It’s hard to face the feelings but it’s important to do so, for the sake of others. Contact...
- Your GP
- Your crisis team
- 911 or the emergency number in your area
- A&E and ask for on duty psychiatrist
- Support helplines, or
- Talk to someone you trust
Conclusion
There needs to be more conversation about this issue, as talking triggers change. It's important to question whether what we are fed about mental illness and violence is actually representative of factual information.
One in four of us have mental health problems, and any person in society can commit a violent crime. The most important thing we need to establish is whether the act of violence is solely attributed to the mental illness. It is prevalent from research presented that this is usually not the case as there are too many other variables involved.
I hope others find this article as interesting as I have found researching and writing it.
Support Resources
- The Samaritans – UK helpline number
- Mind.org — excellent UK resource for all mental health issues with help resources
- MentalHealth.org.uk
- Rethink.org — Carers' guide for those supporting people with mental health problems
- Mind.org (Violence and Mental Health Factsheet)
- 1-800-334-HELP – 24-hour crisis hotline in the U.S.A.
- 1-800-273-TALK – 24-hour crisis hotline in the U.S.A.
- Fliss Baker Talks - My blog