Politics & Policy

Who’s Crazy?

Mental-health experts are wrong. Untreated, the seriously mentally ill are prone to violence.

While virtually the entire nation unites around the reasonable proposition that people with serious mental illnesses should not own assault weapons, one group takes umbrage: mental-health experts. In the wake of incidents such as the one at Newtown, the experts immediately issue press releases claiming that people with mental illness are no more violent than others, leading to the conclusion that people with serious mental illness should not be the target of gun-control efforts.

How can the chasm be so wide? Who is right? The public that believes mental illness is associated with violence, or the experts who claim it is not? The science of violence becomes clear when you look at the totality of violence studies versus any single study. The definitive answer is: It depends on who is mentally ill.

Studies of the 40 to 50 percent of Americans whom mental-health experts claim have some “diagnosable mental disorder” support the claim that “persons with mental illness are not more violent than others.” But the populations in those studies are disingenuously large. Studies of the 5 percent of Americans with the most serious mental illnesses — primarily schizophrenia and treatment-resistant bipolar disorder — who are receiving treatment also support the claim of mental-health experts that persons with mental illness are not more violent than others. But these studies prove only that treatment works, not that persons with mental illness are not more prone to violence. Studies of the 5 percent subgroup of the most seriously mentally ill who are not in treatment and are psychotic, delusional, or hallucinating, or are off treatment that has previously prevented them from being violent, are in fact more prone to violence than others. When people ask whether the mentally ill are more violent, they usually mean this group of severely ill individuals and not about their friends on Zoloft, Prozac, etc.

The mental-health establishment claims that people with mental illness are no more prone to violence than others. At the same time, it claims that, to prevent violence, more money is needed for mental-health treatment. Both claims cannot be true.

There is another gap in the logic of these mental-health experts. They think they are doing a good job with limited resources, but the public disagrees. Over $100 billion is spent on mental health. When more money goes into the system, more people get diagnosed as needing services. The incremental funding is rarely used for the most seriously ill. Witness California: In 2005, California voters passed the Mental Health Services Act, a 1 percent tax on millionaires to provide services for people with “serious mental illness.” As someone with a mentally ill relative, I thank Californians for that. But when the money rolled in, the mental-health system turned their backs on the seriously mentally ill. The California mental-health system diverted money to fund hip-hop car washes, gardens for Hmong, massage chairs for government employees, and public-relations firms to convince the public that all is well. The mental-health experts investigated these reports and found nothing wrong. The state auditor is investigating, and I believe her conclusion will differ.

The mental-health system claims more money is needed to identify who is mentally ill. Not true. Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora; John Hinckley Jr., who shot President Reagan; James Bassler, who shot the former mayor of Fort Bragg; Ted Kaczynski, the Unabomber, who mailed explosive packages; Ian Stawicki, who shot five others and himself in a Seattle café; Eduardo Sencion, who shot National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. — all were all known to be ill before they became a headline. The problem wasn’t lack of identification. It was lack of treatment.

Those of us who wish to improve care for men and women who are most seriously afflicted with mental illness enjoy broad public support. The police are on our side. The parents of persons with serious mental illness are on our side. People with serious mental illness themselves are on our side. The mental-health establishment is not, and that is who politicians listen to.

Who’s crazy?

— D. J. Jaffe is executive director of Mental Illness Policy Org., a think tank specializing in serious mental illness, not mental health.


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