Are the Mentally Ill More Prone to Violence?

We are bombarded today by news events, which portray those with mental illness as robbers, terrorists, and unbalanced individuals who become violent and commit acts of murder and mayhem. How true a picture is this of mental illness? How much does media focus slant our view, or is this simply painting the mentally ill with too broad a brush?

A bipolar client recently told me he was disturbed by thoughts of wanting violence to happen to random strangers as punishment for acts that in his estimation were foolish. However, he did not want to be the one to carry out this punishment, although his fear was that he would become the one to do so. He wanted to know how he could stop these angry thoughts.

How prevalent is violence in the mentally ill? The Los Angeles County Central Jail is the largest mental health facility in the United States. Many of the inmates held in this facility are not those held for aggressive violence, but the mentally ill homeless, a group prone to violence upon one another more for gain (food, clothing, shelter) rather than the desire to vent outrage.

A predisposition toward impulsive acts is a marker of mental illness, while more aggressive acts are thought out and planned. How much does medication address this impulsivity among the mentally ill and how do you get them to comply?

Those with mental illness, both violent and non-violent alike were once confined to hospitals. Society was protected until changes in the 1960’s in our mental health system occurred. At present, both the violent and non-violent are out among the community. While efforts are being made to screen the two groups, there are those who fall between the cracks. Since community treatment centers are largely under funded, the only place for many of the violent is on the streets, in jails, or incarcerated in state mental hospitals for the criminally insane. Instead of being in community clinics as was originally envisioned when the mental hospitals were emptied in the 1960’s, and the“wonder drug” Thorazine was thought to mold addled minds into functional human beings, we see these individuals on the streets where they garner more attention.

The media coverage of a violent act alters our perspective. In the past, violence wasn’t covered by the press as often as today. When we see violent images on our television screen, our inclination is to attribute more to it than it deserves because at that point it is in our faces. Numbers don’t count; numbers aren’t even part of the equation. Instead, we are appalled at what we are being presented with at that moment. A picture speaks 1000 words, and a 1000 words bespeaks a crisis. How do these acts of violence come to exist?

Violence is about frustration and discouragement. In the mentally ill, agitation surfaces unresolved and impulse is reborn as impulsivity and sometimes, aggression. This is not a process of those with mental illness alone. It is about being devoid of sanity; impatience personified by not having one’s basic needs met. Acting out violently on an impulse that cannot be entirely predicted and set against a family unschooled in identifying behaviors and stressors that are aberrant, an opportunity is missed to get treatment for a loved one before she acts out. Since aggressive and impulsive traits run in families, identification of these traits might be enhanced by the family identifying them early. At note here is to what extent are violent acts learned from siblings or parents, and to what extent is it simply bad bio-chemistry. What about the Hinckley’s and Columbines of our times? Is the family responsible? Are these just impulses, or violence planned?

PEI (prevention & early intervention) is one area at the forefront of current mental health outreach. The earlier we are able to identify and intervene, the greater the chance for recovery. At heart is educating the public to identify aberrant behavior while creating the desire to report these individuals. This is neither a blame game nor pointing the finger at the public, the family, or the mental health system. It is not about fault. It is more about the timidity of coming forward as a family member or friend to identify mental illness in our communities. Identification starts at the neighborhood level amongst people who know one another and who make their homes together, talking amongst themselves about mental health outreach programs and the necessity for public education whether private or through organizations such as the Alliance for the Mentally Ill (NAMI) or the Depression and Bipolar Support Alliance. Public institutions, school-based programs, or the media at large can create a knowledge-based community.

Perhaps we as citizens must rescue our mentally ill. How can we do this? By educating ourselves about mental illness and so intervene, we can make more enlightened choices about care. This will help to reduce aggression and violence. Some might call this paternalism. I call it, “Giving a damn.”