Violence and “Mental Illness”: Most Proposed Solutions Would Make Both Worse

After the Newtown, Conn., shooting and other high-­profile crimes committed by people suspected of being mentally ill, there have been many calls for expanded mental health treatment as part of efforts to prevent violence.

If mental health care were a straightforward affair, such calls might be welcomed, and we might expect that both public health and safety could only be improved by more attention to this area.

Unfortunately, in the field of mental health, the wrong solutions easily can make things worse.

Many suggested “improvements” involve reducing confidentiality within mental health care and of increasing the use of forced treatment. Both of these strategies are problematic.

When people feel that talking about their mental state may result in forced hospitalization or get them into databases that are used to reduce their rights, they simply are likely to avoid revealing their problems, and so be denied any opportunity for assistance.

And when people are forced into treatment, they frequently are traumatized as a result, which typically leads to more mental health problems. Later, they are likely to fear the mental health system, and so avoid further treatment even when they need it. The treatments that are mandated by force often are ineffective and may even be harmful.

Poorly thought-out mental health treatment also can increase the risk of violent crime. There is strong evidence that all the major categories of psychiatric drugs can increase tendencies to harm oneself or others, either while taking the drugs or while withdrawing from them.

The selective serotonin reuptake inhibitor antidepressants, or SSRIs, in particular, have been given a black box warning by the U.S. Food and Drug Administration due to their tendency to induce suicidal thinking. Many perpetrators of mass shootings either have been taking these drugs or had recently withdrawn from them. Increasing mental health care without more attention to how drugs can increase risk is not a great way to reduce violence.

And one should not overlook the evidence, documented in Robert Whitaker’s “Anatomy of an Epidemic,” that long-term psychiatric drug use tends to worsen mental health problems.

Another risk is that all the attention directed to the potential of “mentally ill” people to be violent will increase the isolation of people so labeled — and isolation itself tends to increase mental health problems. The public should know that factors like being male, being a young adult, or even being a resident of certain geographic regions are better predictors of violence than is a diagnosis of “mental illness.”

So what would work better? Instead of increasing poorly designed forced treatment that pushes people away from the mental health system and isolates them socially, we must improve the ways our community reacts to all troubled people, so that everyone in need can find support that works for them. The focus really should be on making treatment more attractive and on increasing its long-term effectiveness.

To do this, we need to rethink the way mental health problems are conceptualized, and to really listen to what people who experience these issues have to say in that regard.

An example of progress in this direction is the work of the Hearing Voices Movement. Groups sponsored by this movement allow people to share difficult experiences without having to label them as illnesses, to explore together ways of coping, and to discover innovative strategies for recovery: For example, many find it is not necessary to eliminate the voices they hear, but only to learn to relate to them in healthier ways.

The National Alliance on Mental Illness — Lane County will be sponsoring a presentation on the Hearing Voices Movement at 6 p.m. February 7 — see www.differentminds.us/eshv/ for details. Information about a free discussion and support group can be found at the same link.

Mental health ultimately cannot be separated from social health, and developing an adequate mental health system will require thoughtful dialogue that reflects multiple perspectives and approaches.

Only by engaging in such dialogue can we avoid fearful and knee-jerk reactions that likely will be expensive and ultimately increase both mental health problems and acts of violence.

One option for those interested in such a dialogue is the next meeting of the Opal Network, from 2 p.m. to 4 p.m. Tuesday at the Eugene Public Library, 100 W. Tenth Ave., where the public is invited to discuss the topic “Violence, Fear and the ‘Mentally Ill.’?”