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Talk Back: Violence and the mentally ill: What's the specter, what's the reality -- and what's to be done?

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January 15, 2011|By Tami Dennis / Tribune Health
  • Candles, cards, stuffed animals and signs formed a makeshift memorial outside of the District Office of U.S. Rep. Gabrielle Giffords.
Candles, cards, stuffed animals and signs formed a makeshift memorial… (Kevin C. Cox / Getty Images )

As Congresswoman Gabrielle Giffords inches her way toward recovery, as families mourn those lost in last weekend's Tucson shootings, as speculation about suspect Jared Lee Loughner's mental state is sold as analysis, and as rhetoric over the impact of rhetoric soars once more, the fear of the mentally ill has quietly taken even stronger hold in America's subconsciousness. Or, in some circles, consciousness.

That fear didn't need much help. Notes this SAMSHA overview: "The discrimination and stigma associated with mental illnesses largely stem from the link between mental illness and violence in the minds of the general public."

Few Americans would deny the fact that such a stigma exists. And many would acknowledge it's unfair.

But, writes Vaughan Bell on Slate: "This presumed link between psychiatric disorders and violence has become so entrenched in the public consciousness that the entire weight of the medical evidence is unable to shift it." (Read full post: Crazy Talk: We're too quick to use "mental illness" as an explanation for violence.)

The SAMSHA report faults ... who else? ... the media for the stigma: "This link is often promoted by the entertainment and news media. For example, Mental Health America, (formerly the National Mental Health Assn.) reported that, according to a survey for the Screen Actors Guild, characters in prime-time television portrayed as having a mental illness are depicted as the most dangerous of all demographic groups: 60% were shown to be involved in crime or violence. Also most news accounts portray people with mental illness as dangerous (Mental Health America, 1999). The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments."

And adds Bell in his essay, published via ... what else? ... the media: "Severe mental illness, on its own, is not an explanation for violence, but don't expect to hear that from the media in the coming weeks."

LiveScience writer Stephanie Pappas might disagree with his bleak assessment of the information available to the public.

In her nuanced look at the impossibility of determining cause and effect, she writes: "Neither narrative — 'just crazy' or 'driven to violent action' — really fits, psychologists say. People with severe mental illnesses are more likely than the general public to commit violent crime, said Seena Fazel, a senior lecturer in psychiatry at the University of Oxford. But that doesn't mean people with severe mental illnesses are automatically dangerous.

'The vast majority of violent crimes in society, including homicides, are not committed by people with mental illness. That needs to be clear,' Fazel told LiveScience. 'Most people with mental illness are not violent, and most violent crimes are not committed by people who are mentally ill.'" (Read full post: Insanity, Rhetoric and Violence: No Easy Answers)

Interestingly, Bell and Vaughan quote the same researcher. And both include a link to Fazel's research on schizophrenia and violence.

So let us all continue (not commence, that's already happened) the search for solutions -- not just about how to mitigate the fear, but how to prevent violence. The media do that often, btw -- search, and ask, for solutions.

Here's one suggestion, from DJ Jaffe, described as "Advocate for seriously mentally ill." Writing on the Huffington Post, he urges a change in involuntary commitment and treatment laws to make intervention easier.

"Politicized Pundits and Politicians (PPPs) are on the air now analyzing the ramblings of Loughner, as if they are worthy of analysis. They are already starting to use him as a poster child for gun control or against the Tea Party, or for a Rodney King-style 'can't we all be friends' approach to political civility. But the PPPs are failing to address the reforms that could prevent these incidents." (Read full post: Gabrielle Giffords, Jared Loughner and Mental Illness.)

A recent L.A. Times story notes not just that position but those who find inherent problems with it. In Identifying the violent mentally ill is a challenge, experts say, Melissa Healy and Eryn Brown write:

"Some activists, citing Loughner's apparent early signs of instability, suggest that state laws need to be broadened to allow involuntary commitment of the potentially violent mentally ill. Most states require that a mental health professional find an individual not only to be severely disabled by mental illness but also to be an imminent danger to himself or others before allowing involuntary commitment to a psychiatric facility.

"Others, including many mental health professionals, just as forcefully note that no laws will ensure safety from the violent mentally ill unless state and community mental health services are in place to find them and treat them."

So what to do? Make commitment easier? Provide more treatment earlier? At this point, all suggestions are welcome...

And when it comes to stigma, would such measures help, or hurt? 

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