This article is about a panel at Health Journalism 2008.
Presentations:
Violence, Crime and the Mentally Ill: Myths and Truths, from E. Fuller Torrey, M.D., founder and president, Treatment Advocacy Center
Violence and mental illness: 'Just the facts' on prevalence, prevention, and prediction, from Jeffrey Swanson, Ph.D., professor in psychiatry and behavioral sciences, Duke University School of Medicine
Panelists:
• Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services
• Jeffrey Swanson, Ph.D., professor in psychiatry and behavioral sciences, Duke University School of Medicine
• E. Fuller Torrey, M.D., founder and president, Treatment Advocacy Center
• Moderator: Aaron Levin, senior staff writer, American Psychiatric Association
By Kelley Weiss
Capitol Public Radio, Sacramento, Calif.
News headlines citing mental illness as the cause of violent shooting rampages are becoming more common. But, in a panel discussion at Health Journalism 2008, the audience learned it's not such a simple conclusion.
Jeffrey Swanson, a Duke University School of Medicine psychiatry professor, said there is not a clear answer on whether or not the mentally ill will become violent unless you look at several factors.
"If you give a psychiatrist the task of predicting violence from clinical expertise it's about as accurate as flipping a coin," Swanson said.
That's because how patients act at the doctor's office can be misleading to what their potential risk is, he said. For a more complete picture Swanson said mental health providers need to identify the patient's age, gender, socioeconomic status, mental disorder and arrest and psychiatric hospitalization history. He said if a patient was young, male and poor with a major mental illness and past record of arrest, that person has a 65 percent probability of violence. Swanson said the violence risks are increased significantly if a person with mental illness is also abusing drugs or alcohol.
Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, has bipolar disorder and said that often the media doesn't cover mental illness in a comprehensive way.
"We only get in the papers when we kill somebody," Rosenthal said. "What's up with that?"
He said when the severely mentally ill commit violent acts it is usually because the services to help them have failed.
"The real story is the government putting the right services on the street in an accountable way," he said.
While all the panelists agreed that mental health services need to be improved, Dr. E. Fuller Torrey of the Treatment Advocacy Center said there are other options. Torrey said it's estimated that 2 million people are living with mental illness and not getting treatment. He emphasized that often a mentally ill person denies they need help because of the nature of the disorder – a symptom called anosognosia.
Torrey argued that people with severe mental illness are much more dangerous than the general population. To make sure that the mentally ill are not violent they need an intervention, he said, and that sometimes takes involuntary commitment to a psychiatric facility. Or, he said, making patients comply with medication regiments through a court diversion program.
"The solution is rather simple," Torrey said. "Make sure people with severe psychiatric disorders get treated."
But, Torrey recognized that forcing treatment on the mentally ill is controversial. He suggested increasing assisted outpatient treatment to decrease homelessness and arrest among the mentally ill. He also said, for the most severely mentally ill, long-acting medication injections or implantable devices automatically delivering medicine can be used for transient populations.
