Politics & Policy

Yes, the Untreated Seriously Mentally Ill Are More Violent Than Others

Police line outside the First Baptist Church in Sutherland Springs, Texas, November 6, 2017. (Reuters photo: Rick Wilking)
Denying the truth, for fear it will ‘stigmatize’ the mentally ill, does nothing to get the sickest people the help they desperately need.

When President Trump declared that the shooting rampage in Sutherland Springs was “a mental-health problem,” he set off a barrage of denial by mental-health-industry “experts.”

The National Alliance on Mental Illness (NAMI), Mental Health America (MHA), and the American Psychiatric Association (APA) fired off a volley of press releases and op-eds designed to convince John Q. Public that there is no connection between mental illness and violence. But John Q. Public knows better. And so should the mental-health industry. Rather than deny there is a problem, its leaders should make an effort to fix it.

While researching Insane Consequences, I discovered that one of the most popular phrases in the mental-health industry is “people with mental illness are no more violent than others.” I also discovered that, as commonly understood, this statement is false. It is based on studies of violence committed by the 18 percent of adults with any mental illness instead of the 4 percent with serious mental illness.

When people ask, “Are the mentally ill more violent?” they probably aren’t thinking of co-workers who have mild forms of anxiety or ADHD. They are thinking of untreated psychotic homeless people eating out of dumpsters, screaming that they are the Messiah; they’re thinking of a person like the Sutherland Springs shooter, Devin Patrick Kelley, who had a history of violence and escaping a psychiatric hospital.

If people with untreated serious mental illness are not more prone to violence, then leaders of the mental-health industry should explain why they lock hospital psychiatric units and put them under a system of heavy security, while liver units see no need for guards. Why do psychiatric nurses have to wear panic buttons while those in heart units do not? Why do we have to train police to handle mental-illness calls, but not allergy calls? And why do mental-health outreach workers go out in pairs for their own safety?

It may be politically correct for mental-health professionals to publicly deny the connection between untreated serious mental illness and violence, but they lose all credibility when they do so.

If people with untreated serious mental illness are not more prone to violence, then mental-health experts should explain why they lock psychiatric units and put them under a system of heavy security.

To “prove” that the mentally ill are no more violent than others, mental-health professionals often quote studies of the treated. But those studies show only that treatment works; they do not disprove the link between violence and untreated serious mental illness. Mental-health pros will also quote studies of people “in the community,” but such studies exclude many of the violent: those who were in jails, prisons, state hospitals, local hospitals, and forensic facilities; people who have committed suicide or who lacked the mental capacity to consent to be studied, who were homeless or otherwise not “in the community” at the time of the study. If you exclude the violent from your study population, you will find that the people left are not violent.

The industry also misleads the public with the claim that “people with mental illness are more likely to be victims of crime than to be perpetrators of it.” It’s true that individuals with mental illness are more likely to be a victim of a violent crime than the general population. But it is also true that they perpetrate more crime than the general public does. And the argument is largely irrelevant. The same treatments that reduce violence reduce victimization.

Unfortunately, the New York Times empowered the violence-deniers this week. In an article Wednesday on the mental-health implications of the Texas shooting, it noted that “22 percent [of mass killers] likely had psychosis, the delusional thinking, and hallucinations that characterize schizophrenia, or sometimes accompany mania and severe depression.” Well, less than 4 percent of the population has serious mental illness, which means that a disproportionate percentage of mass killers have a serious mental illness. Instead of acknowledging that in the story’s headline, the Times ran a misleading title: “Are Mass Murderers Insane? Usually Not, Researchers Say.”

Denial of a link between violence and untreated serious mental illness serves the needs of neither the ill nor the public. Why do mental-health pros and their advocates do this? Mental-health-industry leaders believe that admitting a connection to violence is “stigmatizing.” They are more interested in preventing stigma than in preventing violence. But they have the priority backwards. It is violence by the minority that in fact stigmatizes the nonviolent majority. No barrage of violence-denying press releases will trump headlines describing mass murder committed by a person with untreated mental illness.

Politicians should ignore the mental-health industry and recognize that leaving the seriously mentally ill untreated does cause a spike in violence. Politicians should work to get such people treated. Instead, they tend to focus taxpayer dollars on the highest-functioning individuals while ignoring the most seriously ill. As a result of this neglect, ten times as many mentally ill are incarcerated as hospitalized. Sheriff departments in every state are running a shadow mental-health system for the people the mental-health officials ignore.

Two million seriously mentally ill individuals are untreated. We need all hands on deck to get them into treatment. That would be both compassionate and cost-effective. Government should take the $150 billion it spends on mental health and direct it to reducing homelessness, arrest rates, incarceration, victimization, and violence in the seriously ill. The following steps are critical:

1) Eliminate provisions in Medicaid that prevent states from being reimbursed for hospitalization of the seriously ill.

2) Implement “assisted outpatient treatment” programs in every city, county, and state. In these programs, the seriously mentally ill who have a history of hospitalization, arrest, violence, and incarceration caused by their going off treatment can be required by judges to stay in one year of mandated and monitored treatment as a condition of remaining in the community. In the localities where these programs have been implemented, they have reduced homelessness, arrest, and incarceration by about 70 percent and have cut costs to taxpayers by 50 percent.

3) Monitor mentally ill prisoners and involuntarily committed patients who are being discharged from jails and hospitals to ensure they remain in treatment when they move into the community. These are the two highest-risk groups. Devin Patrick Kelley was in both of them.

4) Keep assault-style weapons from people with serious mental illnesses who have a history of arrest, violence, or involuntary commitment — the mental-health industry opposes even that.

Families like mine that have seriously mentally ill relatives are offended by the mental-health industry’s attempts to disassociate itself from the most seriously ill. It makes getting treatment for our loved ones much more difficult and, all too often, impossible. And as the shooting in Sutherland shows, it can also be dangerous — even fatal — for others.

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