NYAPRS Note: Here’s an excellent new piece by longtime NYS based mental health advocate Michael Friedman assailing the false connection between mental health conditions and violence, that’s very much aligned with a piece I wrote for the Times right after the Newtown horror.
Michael goes one very important step further when he points to the longtime conflict between those who say that deinstitutionalization has gone too far and those who believe that there is a vast shortage of community-based services, especially housing, as well as missed opportunities for criminal justice reform and calling for “mental health advocates to ..put their ideological differences aside and work together to achieve changes that everyone agrees are necessary. I, for one, am more than willing to engage in that discussion to best achieve our shared mission to advance the lives of those who need us the most.
Mental Illness Doesn't Mean Mass Murder
The Mental Health System Needs Improvement, But Violence Isn't The Reason
by Michael Friedman LMSW December 13, 2018
Every time there is a highly publicized mass murder in the U.S., there are calls to fix America's "broken" mental health system. This is an unfortunate mistake based on persistent myths that people with mental illness are violent and that anyone who commits such an atrocity must be "sick."
The truth is that:
People with mental illness rarely commit homicide, and few homicides are committed by people with mental illness. About 5% of homicides are committed by people with psychotic conditions.
People with serious mental illness are far more likely to be victims than perpetrators.
Most mass murders are committed by people who are not seriously mentally ill, including:
People who commit purposeful acts of murder or manslaughter or who commit crimes that result in unintended deaths
Perpetrators of domestic violence
People seeking revenge
In its Global Study on Homicide, the United Nations' Office on Drugs and Crime recognizes multiple motivations for murder and divides homicides into three types: socio-political, interpersonal, and criminal. But murder by people with psychosis is so rare that it is included only as a footnote.
People with mental illness are far more likely to take their own lives than the life of another person. This is getting worse. The rate of suicide has increased 20% since the beginning of the 21st century and is now more than double the rate of homicide, which has declined 12%.
There are, of course, many reasons to try to improve America's mental health system, among them:
Its failure to serve 60% of Americans with diagnosable mental disorders
Its failure to provide even "minimally adequate care" more than one-third of the time
Shorter life expectancy of people with serious mental illness
Disproportionate incarceration of people with serious mental illness in jails and prisons
The fragmentation of physical health, mental health, and substance abuse services
Unfortunately, when reducing violence becomes the raison d'etre of efforts to improve mental health policy, there are calls for increased use of coercive interventions -- more involuntary treatment and more use of hospitals generally. Some have even called for a "return to the asylum."
Many mental health professionals favor increasing coercion. But many oppose it, and sadly, an ideological battle has emerged between (1) those who believe that deinstitutionalization has gone too far and (2) those who believe that there is a vast shortage of community-based services, especially housing, as well as missed opportunities for criminal justice reform.
This ideological difference has created a community divided against itself and damaged efforts to achieve needed improvements in the mental health system.
To win beneficial changes, mental health advocates need to put their ideological differences aside and work together to achieve changes that everyone agrees are necessary.
Would a better mental health system reduce homicide? Maybe a little. No one really knows. But there's considerable reason to believe that more and better services could help people suffering from mental disorders and perhaps reduce the incidence of suicide -- goals eminently worth pursuing.
So, when politicians who oppose gun control argue that it is not guns but madmen who are responsible for mass murder, all medical and mental health professionals should strongly counter false claims with the truth about the near irrelevance of mental illness to murder.
Michael B. Friedman, LMSW, is adjunct associate professor at Columbia University School of Social Work and chair of the Geriatric Mental Health Alliance of New York
It Shouldn’t Take a Tragedy to Improve Mental Health Care
Harvey Rosenthal Room for Debate New York Times January 17, 2013
The recent tragedies in Newtown and elsewhere are especially abhorrent to those of us in the mental health community, particularly since studies have shown that people with mental illness are 12 times more likely to be victims of violence, and no more likely to be violent, if they are not substance abusers.
Nonetheless, horrific acts of violence are inevitably associated with mental illnesses, often because the motivations for them seem unfathomable, and they end up getting sensationalized front page coverage.
This has led to a wholesale vilification of conditions that 1 in 5 Americans share. That’s the sort of profiling that has been the fate of some racial or religious groups.
It’s sad that almost the only time meaningful public attention turns to our community is in the wake of tragedies. Our systems desperately need attention. We now know so much about how to help people in need, but the use of effective approaches is the exception not the rule.
We need more money. But we can also redirect a lot of money invested in outmoded institutional or office-based approaches into community outreach, engagement, relapse prevention and crisis support services. National and state health care reforms can expand the use of these approaches.
On the other hand, the use of court ordered treatment associated with Kendra's Law has not, on its own, proven to be effective….
We're not violent, so controlling us will not make you safer. On the other hand, investing in and improving services, as is being done by long awaited health care reforms, will bring critically needed help to millions….