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Why We Need to Quit Linking Mental Health Reform & Violence

Mental health care reform shouldn’t be equated to just personal safety concerns.

Photo purchased from iStockphoto, used with permission.
Source: Photo purchased from iStockphoto, used with permission.

Everywhere you turn lately, from our communities to Capitol Hill, voices are being raised in a call for mental health care reforms. This encourages me, but also raises some concerns.

It encourages me because it’s about time. For the past few decades, we’ve spent much more effort dismantling support networks for those dealing with mental illness than strengthening them. Our last attempt to address the issue on a national scale, in fact, was in 1963 when lawmakers passed the Community Mental Health Act championed by President Kennedy.

So why does the call for reform worry me? Because of the context of the conversation. When mental health reform is mentioned, it is inevitably linked to tragic acts of violence.

Consider this wording, part of an Aug. 11 analysis in U.S. News and World Report of two mental health reform bills currently being debated by the House and Senate:

It's as if Congress went to sleep for 50 years on mental health issues. But the nightmares woke us all up: Newtown, Aurora, Tucson, Lafayette, Isla Vista, Virginia Tech, Columbine and too many others.

Or consider this billboard that recently appeared in New York City, courtesy of fashion design company Kenneth Cole:

Over 40M Americans suffer from mental illness. Some can access care … all can access guns.

These examples are all too common, and the implication is clear. Mentally ill equals dangerous.

The reality, however, is far different. Consider these facts:

  • Research confirms that those with psychiatric disabilities are more likely to be victims of crime than the perpetrators.
  • Only about 3-5% of violent acts can be attributed to those with a serious mental illness, according to the U.S. Department of Health and Human Services (HHS), meaning the vast majority of those with a mental health issue are no more likely to be violent than anyone else.
  • In an interview with ProPublica, Dr. Jeffrey Swanson, one of the nation’s leading researchers on mental health and violence, noted that a history of any kind of violent or assaultive behavior is a better predictor of future violence than a mental health diagnosis.

Of course, no one needs to wonder if someone who is capable of taking a gun and shooting elementary school children is mentally ill. How can they not be? We can never ignore the reality that mental illness can sometimes lead to violence and that we need to create processes that can identify and help those at risk of hurting others before tragedy ensues. But we risk labeling every mentally ill person as scary, unpredictable and dangerous if we look at only the horrifying examples when speaking of the need to reform the way we deal with mental illness.

That’s more than just inaccurate and unfair; it makes our country’s mental health worse in the long run by keeping stigma against the mentally ill alive and well. About one in five American adults is dealing with a mental illness in any given year and about half the population will develop at least one mental illness in their lifetime, statistics show. That means the chances are very good that someone you care about — and perhaps you — will fall into the category of “mentally ill” at some point. How likely will they be to reach out for help if they fear being lumped in with the Adam Lanzas and Dylan Klebolds of the world?

We need mental health reform. We need more programs that reach out to the young, before problems can take hold and before substances such as drugs and alcohol become a way to medicate away distressing feelings. We need better access to care so that no one has to wait 10 days in an E.R. for a mental health bed to free up, as what recently happened to a 19-year-old woman. And we need a way for families to remain part of the treatment process when someone they love is struggling with their mental health. Change is long overdue, but if we get it in a way that discourages people from seeking the very help we hope to offer, then we only risk more tragedy.

Rather than just the nightmares waking us up to the need for mental health care reform, we should also be awakened by the millions who are dealing bravely, and oftentimes with little support, with issues such as depression, anxiety, mood disorders, personality disorders and much more.

Suicide is a much greater risk for this population than violence against others. And if you want proof of the pain that can come with mental illness, consider this heartbreaking fact: A study that looked at those who requested euthanasia in Belgium, where the practice has been legal since 2002, found that 100 people over a four-year period asked to be allowed to die on grounds of the “unbearable suffering” associated with their mental illness.

There is hope, however, and that’s why it’s worth investing in a better mental health care system and better access to it. With treatment and support can come remarkable transformations in quality of life. In fact, notes the HHS, most who are dealing with mental health issues get better and many recover completely.

Fighting the Stigma

There are some encouraging signs that a broader and more enlightened conversation about mental illness is beginning. The Kenneth Cole billboard, for example, didn’t last too long before outrage from mental health organizations and others brought it down. And campaigns to fight the stigma surrounding mental illness are becoming more and more common and getting a big boost from social media. Check out Be Vocal, National Day Without Stigma and World Mental Health Day.

Such efforts are important reminders that when we talk about mental illness, we aren’t just talking about the perpetrators of horrifying crimes. We are talking about our neighbors, our friends, our family and ourselves. Mental health care reform shouldn’t be thought of as something to keep ourselves safe from the “crazy” people, but something we do to ensure all of us have a chance at our best and healthiest life.

Dr. David Sack is board certified in psychiatry, addiction psychiatry and addiction medicine. As CMO of Elements Behavioral Health, he oversees mental health treatment programs at Lucida Treatment Center in Florida, The Ranch in Tennessee, and Malibu Vista in California.

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