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Public Education & Policy :: Position Papers Myth Fact Sheet The Link Between Violence And Mental Illnesses May Not Be What You Think It Is If you have been following the debate in the media and elsewhere regarding the attempt to increase forced treatment of people with mental illnesses in California, you probably have read statements like this many times. "Americans with untreated severe mental illnesses represent less than one percent of the total U.S. population. These individuals commit nearly 1,000 homicides each year, or between four and five percent of the total annual murders." Statement by the Treatment Advocacy Center (TAC), retrieved from the Internet in November 1999 http://www.psychlaws.org. Most statements about violence and mental illness are untrue. The 1,000 murders a year lie is a distortion of U.S. Department of Justice (DOJ) homicide information. Consider what the National Stigma Clearinghouse has to say about this: "This is incorrect. The DOJ, in a study using 1988 homicide data from 33 urban counties in 20 states, posed a variety of questions to families about the lives of members who had committed homicide. Families were asked to answer yes or no about perceived mental illness, suicide attempts, and hospitalizations, which occurred at some point during the person's life. The data indicated some history of mental illness in 4.3% of homicides. Contrary to TAC's explicit claims, the study makes no mention of "untreated" mental illness, schizophrenia, manic-depression, or any other diagnosis. Equally, there is no basis for extrapolating the 4.3% of the national population. TAC arbitrarily raised DOJ's homicide estimate from 4.3% to 5%. Then they arbitrarily attributed these homicides to less than 1% of the U.S. population, the number TAC says have "untreated schizophrenia and manic-depression." In another error: 4.3% of 16,914 (the total homicides in 1998) is 727, not 1,000 as TAC claims. And DOJ's predictions for 1999 will lower the figure still further to 645." Note: Statement by the National Stigma Clearinghouse retrieved from the Internet in November 1999. The complete statement can now be found in at: http://www.madnation.org/vicki/taclies.htm. Here is the truth: "The prevalence of violence among people who have been discharged from a hospital and who do not have symptoms of substance abuse is about the same as the prevalence of violence among other people living in their communities who do not have symptoms of substance abuse. The prevalence of violence is higher among people - discharged psychiatric patients or non-patients - who have symptoms of substance abuse. People who have been discharged from a psychiatric hospital are more likely than other people living in their communities to have symptoms of substance abuse. The prevalence of violence among people who have been discharged from a psychiatric hospital and who have symptoms of substance abuse is significantly higher than the prevalence of violence among other people living in their communities who have symptoms of substance abuse, for the first several months after discharge. Violence committed by people discharged from a hospital is very similar to violence committed by other people living in their communities in terms of type (i.e. hitting), target (i.e., family members), and location (i.e., at home)." The MacArthur Violence Risk Assessment Study, Executive Summary, April 1999. The Link Between Violence And Mental Illnesses May Not Be What You Think It Is You may also have heard that people with mental illnesses have broken brains and are unable to make decisions about their care. Most people with mental disabilities are competent to make decisions about their treatment. Patients hospitalized with mental illness more often showed deficits in their decision-making performance compared with hospitalized medically ill patients and non-patient control groups. This was especially true for patients hospitalized with schizophrenia, and to a lesser degree for patients with depression. Nevertheless, the majority of patients hospitalized with schizophrenia performed adequately on any particular measure of decision-making ability, and about half did well on all the measures combined. MacAuthur Treatment Competence Study(1) Executive Summary, April 1999. When people do have trouble making treatment decisions, they can be provided the assistance they need to retain their autonomy and their decision-making rights. When patients manifest serious deficits in their abilities to make treatment decisions, there are good reasons why an attempt to correct or compensate for these deficits should be considered to be an essential part of the evaluation. From a principled perspective, given the importance of the value of autonomy, it is always important to aid patients in retaining the right to make their own decisions. From a practical point of view, the likelihood of a successful treatment outcome often is enhanced by maintaining the patient's motivation and commitment to treatment, which is more likely if the patient is involved in making the treatment decision. Grisso and Appelbaum, Assessing Competence to Consent to Treatment. In the words of the U.S. Surgeon General: "Typically, people retain their personality and, in most cases their ability to take responsibility for themselves." Prepared by the California Network of Mental Health Clients |
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