Mental illness and violence: Let’s change the conversation
Whenever there is a mass shooting or act of violence, people tend to resort to the same, tired talking points: calls for “thoughts and prayers,” pros and cons of gun control, and, when the perpetrator turns out to have a history of mental illness, the need for improved mental health care.
Unfortunately, there’s an inherent stigma and inference that people with mental illnesses are prone to violence. This isn’t true. Those being treated for their mental illnesses are no more prone to violence than the general population. In addition, most people with severe mental illnesses weren’t violent or criminals prior to becoming ill.
I propose a change in the way we discuss this. I propose that we describe things more accurately, by saying that sometimes crimes are committed by a person with an untreated or under-treated severe mental illness.
The list of barriers to receiving mental healthcare consists of many factors: de-institutionalization, closures of mental health beds at all levels of care — from acute care in hospitals, to sub-acute care to long-term care in private and state-funded facilities. Add to that the reality that insurance companies limit stays and the constant push to provide fewer services once a person has stabilized, and this situation becomes more difficult. Too few psychiatrists and mental health professionals (in all settings) further compounds these difficulties.
Because these illnesses are brain disorders, those with a severe mental illness can also have a condition, called Anosognosia, in which their brain tells them they aren’t sick or that their medications are poison, and, therefore, they stop taking their medications. In the past, when atrocities were happening at some mental health facilities, the ACLU stepped in to help protect the rights of patients to refuse treatment. While the intentions were good, the consequences have proven to be tragic. Many patients are left untreated and suffering, resulting in repeated hospitalizations. Many end up homeless, in county jails, or state prisons. Sadly, many die.
First, we must address the issue of the patient’s right to refuse treatment vs. the need to protect them for their own well-being. We have already figured out how to do this for our elderly relatives who suffer from brain disorders like Alzheimer’s. We can work with doctors and judges as needed, to determine how to best care for these patients so they don’t end up homeless and untreated. If we can devise a system that helps dementia patients, surely we can help those with severe mental illnesses like schizophrenia and bipolar disorders. I would argue it’s far crueler to allow people to go untreated and with voices giving them horrible suggestions or delusions that torture them, than to stabilize, treat, and care for them.
Second, we need to open or re-open more of the long-term care beds and care for the people with the most severe illnesses that truly need to be in facilities, both private and public. Again, this frees up acute care beds in hospitals and allows those in crisis to gain access to emergent care when they need it.
These two measures alone would reduce the number of people who are “untreated” or “under-treated” for severe mental illnesses. In addition to improving public safety, these changes would significantly improve the lives of our most vulnerable citizens. This doesn’t solve all instances of mass shootings and violence in our state and country, but it’s certainly a step in the right and compassionate direction.
For now, I’m interested in at least changing the conversation so that more people understand that those with treated mental illnesses don’t often commit crimes of violence, but sometimes people with untreated severe mental illnesses do. Perhaps we can change hearts, minds, legislation and mental health care access for some of our most vulnerable citizens with severe mental illnesses.
Who’s with me?
Leslie Carpenter is a National Alliance on Mental Illness Johnson County board member and a mental health advocate.
Click here to review letter in the Des Moines Register