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The Association between Mental Health Illness and Violence

Since Friday December 14 it has been very hard to turn away from the Sandy hook tragedy. As a parent its hard not to feel some amount of pain for what these parents are going through. It is hard to loose any loved one, let alone such young children whom barely started living. As a parent of a toddler I wince at the thought of coming home and not seeing my daughter, and fear the thought of my life without her. Unfortunately in the last five years there have been many parents living in that darkness, and that pain will never go away. In the last five years there have been 19 mass shooting, and an untold number of violent shootings around the country. Our lawmakers need to explain to their constituents the loopholes that currently exists in gun laws, and why nothing has been done since 2004. Gun laws federal and state are supposed to have provisions in place to prevent individuals with histories of mental illness and violent tendency from purchasing guns, but through loopholes in both federal and state gun laws this rule seems to only apply to individuals that have been institutionalized or deemed dangerous by authorities. In many cases the databases are not linked and the information is old, and lastly these rules are completely washed away by going to a gun show. The majority of Americans know gun laws are lacking, but what about the mental states of these individuals committing these violent acts. Adam Lanza was diagnosed with Aspergers syndrome, and went on to kill 26 individuals. James Holmes was receiving mental health treatments and went on to kill 12 individuals at a movie theater. Jared Loughner declared mentally ill and a schizophrenic killed 6 individuals. These are three of the last mass shooting assailants within the last year or so, and then there are the smaller incidents we never hear about on a national level. In Bloomington Ill a 14-year-old boy accused of firing gunshots into the ceiling of a central Illinois high school has pleaded guilty but mentally ill. The list goes on, and on. Are there associations correlating mental health issues and violence? Do individuals with mental health issues have a higher tendency to commit such crimes? Lastly what are the signs to look for as a parent, neighbor, or friend?

Are the mentally ill at increased risk of violence?

The MacArthur Violence Risk Assessment Study (1) did a study in the early 2000s to evaluate this question. Studying 1,136 subjects using multiple measures of violence, including patient selfreport, to help minimize bias in the studys finding. The results concluded that mentally ill individuals express an equal and undistinguishable amount of violence as their non-mentally ill neighbors do. However if you add substance abuse in addition to mental illness the number increases significantly. Those with schizophrenia had the lowest occurrence of violence (14.8%), compared to those with a bipolar disorder (22.0%) or major depression (28.5%). The inclusion of substance abuse in a non-mentally ill individual have an effect of increasing aggression however

the numbers are very telling when added to mentally ill individual. The study concludes that mentally ill individuals may exhibit visible aggression but no more than any one else, however when substance abuse is added the risk factors for violence are high. The severity of mental illness does play a role in acts of aggression. Individuals suffering from psychotic symptoms that cause them to feel threatened or manipulated by outside forces have a greater tendency towards violent behaviors.

Is the public at risk? Is the public at risk?

We have learned that substance abuse increases the violence of mentally ill individuals, but who are their target? Studies and research suggest there are several catalyst or conditions that may trigger extremely violent attack by those that are mentally ill. These conditions are often linked to conditions in their social life, and closest social interactions. In the MacArthur violence risk assessment study likely recipient of violence are family members (87%) and the violence typically started or occurred at the home. Mentally ill patients were less likely 10% to target complete strangers compared to community members 22%. In many of the mass violent crimes we have experience in the last 5 years, if the crime does not occur at home, it occurs within the community of the attacker.

What are the signs to look for as a parent, neighbor, or friend?

History of violence:
A past history of violence maybe a telling sign of future risks and violent behaviors. Mentally ill individuals that have a history of violence or aggression may be at increase risk to exhibit future violent and aggressive behaviors.

Substance Abuse Problems:

Drugs, alcohol, and other substances significantly increase the likelihood of violence. Drugs and alcohol increase the risk of violence in any individual, however with mentally ill individuals these factors significantly act as determinants of violence.

Homelessness, lack of social support, bullying, anxiety, and family stress are factors suggested to contribute towards violent behaviors.

Studies have shown that young males with mental illness have a higher risk factor for associated violence.

In analyzing this study in the wake of the Sandy Hook shooting here are some key findings based on data and not raw emotions. 1) Having a mental health/illness issue or a social disorder does not cause an individual to be violent or infer and individual will commit a violent act. 2) The number of mentally ill individuals that commit act of violence compared to non mentally ill individuals are indistinguishable and very small. 3) Family members are usually the first recipients of violence. 4) Complete strangers are less likely to experience violence from a mentally ill patient compared to members of their community, social circle or family. 5) Substance abuse appears to be a large determinant in violence, and management of substance abuse disorders among seriously mentally ill patient may help prevent violence. As we mourn the lives of the 26 and countless others that have been taken as a result of violence, we have to remember the heinous crimes were the act of a few mentally ill individuals and that being mentally ill does not make you violent. As members of various communities its up to us to be aware of some of these signs listed above, we may witness these signs in our communities, home or neighbors. Its imperative we going beyond contacting our lawmakers, and look at we can do to help prevent some of these violent crimes, we never know when the violence will come knocking on our door. Reference: 1. Monahan J. Steadman HJ. Silver E, et al. Risk assessment: the MacArthur Study of Mental Disorder and Violence. Oxford: Oxford University Press; 2001. 2. Applebaum PS. Robbins PC. Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000;157:566572. provides the latest news and updates related to the Affordable Care Act and its implementation as well as other news updates on health care related items in the United States. To be informed of the latest news and updates related to the Affordable care Act please visit