As lawmakers across the country continue to pass ill-conceived laws implicating people with mental illness as having a greater penchant for violence (despite the scientific evidence that says otherwise), a new study has come out showing what most mental health advocates have long known: that the real risk for people with mental illness is becoming a victim of crime, not a perpetrator of it.
The study, published in The Lancet Psychiatry, examined the characteristics of homicide victims and found that people with mental illness are two and a half times more likely to be victims of homicide than people in the general population.
“Historically, society has been more concerned about the risk of patients committing violence than the vulnerability of patients to violence,” said Dr. Louis Appleby, the study’s lead author and a professor of medical and human sciences at The University of Manchester in the UK. However, there is an abundance of evidence demonstrating that mental illness is a risk factor for victimization, not perpetration, of violent crimes.
These new findings add to that evidence, showing that the average mental health provider can expect to see one of their patients murdered roughly every 2 years.
Using data from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, the researchers examined characteristics of the victims and perpetrators of all homicides in England and Wales between January, 2003 and December, 2005.
The results showed that during the 3-year study period, 1496 people were victims of homicide, and 6% (90) of them had been under the care of mental health services in the year before their death
“Assessing patients for risk of suicide and violence is common practice, but screening for risk of becoming victims of violence is not,” Dr. Appleby said. “[P]roperly assessing these risk factors should become a key part of clinical care plans.”
Myths and Misconceptions
As we’ve seen time and time again, mental illness is often implicated as the cause of violent crime. In the wake of mass shootings, the national dialogue inevitably turns to ‘fixing’ the mental health care system as a solutions to gun violence. However, a large body of evidence shows that the supposed link between mental illness and violence is a myth — and nothing more.
In one large study, researchers analyzed data derived from the entire population of Sweden over a seven-year time period (2001-2008) and found that people with a mental illness were five times more likely to be victims of homicide than the general public. The researchers looked at a wealth of demographic data and characteristics — such as gender, race and income — to ensure these variables might not be contributing to the relationship the researchers found.
They found that the risk of being murdered was highest, at nine-fold, for people with substance use disorders, a number that may of course be subject to confounding lifestyle variables. But it was also increased for people with other mental illnesses in a way that couldn’t be explained by substance use.
Those with diagnosed personality disorders, for example, had a 3.2 times increased risk of being a victim of murder. For depression, the risk was increased by a factor of 2.6, for anxiety disorders, 2.2, and for schizophrenia, 1.8.
In another study, Dr. Sarah Desmarais and her colleagues at N.C. State University analyzed a database of 4,480 mentally ill adults who had answered questions about both committing violence and being victims of violence in the previous six months. They found that people with mental illness were significantly more likely to have been victims than perpetrators of violence, and nearly half — 43.7 percent — of victims of violent crime had been victimized multiple times.
“This highlights the need for more robust public health interventions that are focused on violence. It shouldn’t just be about preventing adults with mental illness from committing violent acts, it should also be about protecting those at risk of being victimized,” said Dr. Desmarais.
A meta-analysis of studies on the topic between 1990 and 2010 found that the odds of any type of violent victimization — including physical, sexual or partner violence — for people with a mental illness are almost four times higher than for adults without any disability. Additionally, the rate of victimization for adults with mental illness were found to be far higher than for individuals with other disabilities.
Overall, less than one percent of people with severe and untreated mental illness go on to commit a serious violent crime (one resulting in serious or permanent injury). Moreover, only 3-5 percent of American gun crimes involve “mentally ill shooters,” while the remaining 95-97 percent is committed by people without mental illness.
Despite a wealth of evidence showing that mental illness is not a significant cause of violent crime, most of the general public believes it is.
A longitudinal study of American’s attitudes on mental health between 1950 and 1996 found, “the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled.” Also, the vast majority of Americans believe that persons with mental illnesses pose a threat for violence towards others and themselves.
Furthermore, the discrimination and stigma associated with mental illnesses stem, at least in part, from the link between mental illness and violence in the minds of the general public. The effects of such stigma and discrimination are profound. The New Freedom Commission on Mental Health found that, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders – especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment.”
One of the ways these myths are spread is through inaccurate media coverage. For example, research shows that most news accounts erroneously portray people with mental illness as dangerous. According to Mental Health American, 60 percent of characters in prime time television with mental illness were shown to be involved in crime or violence.
Moreover, researcher Otto Wahl of George Mason University found that, “the vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses”
It is a sad commentary on the nature of public interest that the estimated 1 percent of individuals with untreated severe mental illness who commit acts of violence grabs so many headlines while the 25 percent of those who fall victim to violence generate so few.
Has any lawmaker in the U.S. suggested a law to better help and protect the population most at risk for becoming a victim of violence?
Not a one.
Despite the clear evidence showing that people with mental illness are far more likely to be victims of violence than perpetrators of it, we continue to stigmatize this population by implicating them as dangerous and violent criminals. As long as we go on ignoring the evidence on gun violence — which shows that guns are the biggest risk factor for gun deaths and injury — we will not make progress towards ending America’s gun violence epidemic.
It’s time to stop letting the NRA control the debate over gun violence, and start letting the evidence speak for itself.