violence and mental illnessAnother tragedy strikes, and the shock waves it casts spread far. The recent massacre in Colorado has led to an outpouring of horror, concern, and sympathy for the victims and their families. It has also fueled new debate on topics ranging from gun control to better predictors of violent behavior. And with the appearance of the glassy-eyed, cartoon-haired accused perpetrator in court, the topic has once again turned to violence and the mentally ill.

Amid all the speculation, let's take a moment to look at some important facts, and separate them from the myths about mental illness:

FACT: Mental illness is not a major cause of violent behavior.

According to research, only about 3 – 5% of violence in the population is due to the presence of serious mental illness. Other factors create a much greater risk, such as substance abuse, history of violence, and social conditions.

Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University, reviewed the results of a comprehensive project, the MacArthur Violence Risk Assessment Study, and noted: "Having a severe mental illness alone doesn't predict anything," as far as violence goes. Individuals with severe mental illness "are no more at risk for committing a violent act than anyone in the population." The MacArthur study found that individuals with major mental illnesses who didn't abuse substances had no greater likelihood of violence than others in their neighborhoods.

Muskin's colleague, Paul Appelbaum, M.D., a former president of the American Psychiatric Association, summarized many of the findings by stating: "If you take the body of data as a whole, I think what everyone would agree with is, if there is an impact of mental illness on violent behavior it is not very great. And there is no question that the overall contribution of people with mental illness to violence in our society as a whole is quite small."

FACT: Treating mental illness further reduces any risk of violent behavior.

Individuals whose mental illness receives treatment are no more likely to be violent than the general population. One study found that psychiatric patients who had received hospital treatment had no higher rates of violent behavior than people without any type of psychiatric disorder, even one year later.

FACT: The general public is not statistically at risk.

While isolated incidents may lead the public to fear that they may be likely victims of a deranged individual, the MacArthur study also found that, even what violence occurs, it is much more likely to occur with family members or friends, and in the home. That is true of most violence in society, regardless of one's health profile. In fact, this study found that discharged psychiatric patients were less than half as likely to target complete strangers as were others without mental illness.

FACT: Other social factors increase the likelihood of violent behavior.

One important aspect of the MacArthur study was the comparison of mental patients with a "control group" consisting of individuals who came from the same neighborhoods and social backgrounds. In some previous studies, elevated rates of violent behavior in individuals with mental illness were associated with generally higher rates in individuals who live in disruptive social settings; e.g., homelessness, poverty, etc. In other words, because of the stigma and other impacts of mental illness, psychiatric patients tend to have higher rates of poverty, substance abuse, and victimization than the general population. The poor, minority, inner-city teens who demonstrate higher violent crime rates can't have their behavior attributed to their race, for example, but to their social environment. In much the same way, an individual with serious mental illness may be more likely to live in an environment that breeds violence, but their illness is not a cause.

FACT: Individuals with mental illness are more likely to be the victims of violence than the general public.

In one study of hospitalized psychiatric patients, almost two third reported that they had been physically victimized by a dating partner in the previous year. Almost half of those who lived with family members reported being victimized physically over the past year. Another study found that individuals with a history of severe mental illness had an 8.2% rate of criminal victimization over a period of four months, as compared to only 3.1% of the general population.

In many instances, these individuals responded to bullying and victimization with their own self-defensive or violent reactions—again a reaction that has been found in the general population. Untreated mental illness makes an individual vulnerable to attacks and exploitation by others. Sometimes these circumstances lead to aggression by the victim. Just like individuals who have been the victims of child abuse are unfortunately more likely to become violent with their own children, another vicious cycle is created when individuals with serious mental disorders are preyed upon by others. Many individuals with serious mental illness may need protection (and treatment) more than suspicion.

These facts don't reduce the horror of recent events or offer a defense or apology for any alleged criminal. But they do offer information that can perhaps help us pause in our debates, and not give in to fear – a fear that can trouble those who need not worry and stigmatize those who are innocent.  Let's try to think past some of the headlines, and have caring concern for those neighbors who need our understanding most.

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