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There is rampant hysteria today about the mentally ill being dangerous and having access to guns. To some the mentally ill are the major problem with gun violence. Take for example, Ann Coulter’s recent headline: “Guns don't kill people, the mentally ill do”.  

Too often government policies are based on these erroneous beliefs as legislatures are spinning off new laws to constrain the mentally ill. New York state passed a law dirercting therapists to report any client thought to be “likely to engage in” violent behavior to the police. Such prediction is very difficult to do accurately and results in many false positives.  

The impetus for the current flurry of concern is the Sandy Hook Elementary School shootings, coming on the tail of the Tucson and Aurora shootings. Contrary to the media hype, these horrific events are but a drop in the bucket of the scandalously high number of violent and murderous acts that happen in the U.S. daily. The vast majority of such acts of violence and murder are perpetrated by people who are not the seriously mentally ill. This is not to say that the perpetrators don’t have some of their own problems including anger, lack of self control, feelings of persecution and disenfranchisement, and misplaced desire for revenge, but most are not the seriously mentally ill.

Due to historical factors such as equating mental illness with evil and demon possession, along with disproportionate media coverage, the public has seriously over blown beliefs concerning the mentally ill and violence. Public perception is wrong and strong:61% believe that people with schizophrenia were more likely to act violently to others, and 33% felt people with Major Depression were likely to be violent.

These beliefs are present throughout the media and popular culture. For example The Screen Actors Guild survey showed that characters in prime time TV portrayed as having mental illness are depicted as the most dangerous of all demographic groups: 60% are shown to be involved in crime or violence. Yet it is the currency of the high profile incidents along with the long standing superstition and stigma that pervades and molds the public’s and policy makers’ views of mental illness.

The Rake's Progress where he ends up in Bedlam Hospital due to his debauchery
A Rake's Progress, Wm. Hogarth, Bedlam, 1733

What are the facts?

There is now quite good epidemiological and population research both in the U.S. and abroad concerning the relationship between mental illness and violence that I will briefly review in an attempt to lay out the data as we know them today.

If you ask as many have, “Are the seriously mentally ill largely responsible for societal violence?” the answer is clearly and emphatically, “no.” Here we define Seriously Mentally Ill (SMI) as someone with a diagnosis of Schizophrenia, Bipolar Disorder, or Major Depression and related serious major mental disorders. Typically these are the people who are likely to end up in a mental hospital at some time in their lives.   If you ask if SMI are disproportionately involved in violence, relative to the general population, you might get an answer of yes, or maybe, but only under certain circumstances. Taken without appropriate qualification, SMI is at best only slightly or not at all, disproportionately associated with violence. It is important to know what some of the qualifying circumstances are.

Until the past decade or so our data on SMI and violence was unclear and often contradictory. The extant studies were often restricted to certain locales and used convenience samples that were relatively easy to study. Most samples were not representative of all mentally ill individuals, but only of those with the highest risk of becoming dangerous, such as those who are hospitalized or arrested.  Few studies assessed for the numerous socio-demographic, historical and clinical variables that themselves were significantly associated with violence. Thus, it was impossible to differentiate which factors were related to violent behavior and seldom were these variables all examined for their individual contributions. In the late 1990s, the MacArthur Foundation supported a series of studies that became the gold standard today for designing and conducting studies on violence and the mentally ill.

The MacArthur Violence Risk Assessment Study has produced a series of comprehensive studies taking into account the shortcomings of previous research. Their team of experts, headed by John Monahan, developed scientifically valid methods and procedures that have enabled replicable findings by others.  These methods assess the major individual known risk factors for violence and their interactive relationships to the mentally ill.

Are Seriously Mentally ill patients dangerous and violence prone?

The first answer is at best, “marginally so” if we take into account whether they have some other more potent characteristics. The MacArthur studies and those that followed them find that the combination of a Serious Mental Illness diagnosis, along with a dual diagnosis of alcohol or substance abuse, is the most important combination for predicting violence from the mentally ill. This association is also found to hold across several U.S. communities studied as well as other countries including Sweden and Canada. And yet, people with these characteristics account for but a small fraction of violence in our societies.

Perhaps the most consistent and important finding of these and subsequent studies is that simply using the category of “SMI” grossly overestimates the role of mental illness in violence. A major conclusion from the MacArthur studies follows:

The prevalence of violence among patients discharged from a hospital and who do not have symptoms of substance abuse is about the same as the prevalence of violence among non-SMI other people living in their communities who do not have symptoms of substance abuse. That is, knowing that someone has just been released from a mental hospital does not help you predict violence unless you know that they also have a dual diagnosis of Substance Abuse. Although they do have an elevated risk for violence, relative to the general population, it is not different from those living in the same geographic and socioeconomic circumstances.
Thus, it is not SMI itself that is associated with violent behavior but its interaction with substance abuse along with a number of other factors including where they live when they return from a hospital stay.

What other variables contribute to predicting violence in the mentally ill?

The MacArthur studies also found a number of other independent risk factors that were statistically important in predicting violence in addition to substance abuse among the SMI. These factors include: Antisocial Personality Disorder, being male, and of younger age.  Family experiences such as having been abused as a child and having a father who used drugs were also of importance as were having had prior arrests, difficulties with anger control, violent fantasies, and feeling threatened.  Recent stressors such as divorce, victimization, and unemployment were also statistically related to violence among patients. These are the same factors that are predictive of violence in any group.

These studies have made it clear that simply having a SMI diagnosis tells us relatively little about whether a given person will act in a violent manner. Rather to understand the role of SMI in violence one must take into account these socio-historical, economic, and clinical factors. Given the newer methodologies, these findings have been substantively replicated now.  

Another major clinical risk factor associated with SMI and violence is whether they are under treatment at the time and are complying with their medication regime. Thus treatment availability and maintenance is critically important.

Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with serious mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment. The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled.
Who are the victims?

 In those cases where a SMI person does display violence, their actions are seldom random. Rather they typically involve family members (87%) and, occur at home as is true for most acts of violence in the community.  In the MacArthur studies, only 10.7% of violent acts among discharged patients were toward complete strangers. Comparable figures for such violence toward strangers among community controls (non-patients) was 22.2%.Thus, the mentally ill are only half as likely to harm strangers as people from a general community population.

Most people with SMI are not violent and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. One study by Teplin et al. found that those with SMI are 11 times more likely to be victims of violent crime than the general population. And another found victimization to be somewhat less but still the rate was two and a half times greater than in the general population--8.2 percent versus 3.1 percent.  This heightened risk for victimization is likely in part due to often living in undesirable neighborhoods and being homeless.

Another sad truth is the SMI are often their own victim in that the most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, there were almost 35,000 suicides, nearly twice the rate of homicides (14,612). Suicide is the 10th leading cause of death in the United States. Although we do not know the exact numbers of SMI who commit suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit. The major method of suicide is by firearms – over 50%.

The rate of suicide among patients diagnosed with Schizophrenia is estimated to be ~5%, much higher than the general population. That for major affective disorders such as Major Depression and Bipolar Disorder is even higher. Taken together, suicide takes a huge toll on SMI.

How much physical violence in our society can be attributed to persons with SMI?

Swanson and colleagues reported population attributable risks for self-reported physical violence.

For those with a major mental disorder, the population attributable risk for physical violence was 4.3%, indicating that violence in the community could be reduced by less than five percent if major mental disorders could be eliminated. The population attributable risk for those with a substance abuse disorder was 34%, and for those with a comorbid mental illness and substance abuse disorder it was 5%. Therefore, by these estimates, violence in the community might be reduced by only 10% if both major mental disorders and comorbid disorders were eliminated. However, violence could be reduced by over a third if substance abuse disorders were eliminated.  
 (Swanson JW. Mental disorder, substance abuse, and community violence: an epidemiologic approach. In: Monahan J, Steadman HJ, editors. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press; 1994. pp. 101–136)
A Canadian study similarly found 3% of violent crimes attributable to SMI and 7% to substance abusers. A study of Swedish patients found an attributable risk of 5.2% of patients including those with substance abuse disorders. So, the estimates from several studies and countries suggest that by removing the mentally ill from society, we could reduce violent crime by between 3 and 5%, leaving 95 to 97 percent of societal violence untouched.

So, Ann Coulter is wrong, Wayne LaPierre is wrong, and the general public is misinformed. The seriously mentally ill are not the major causes of violence in the U.S. or elsewhere in the world. Although some mentally ill are involved in violent acts, their participation has less to do with being mentally ill per se than it does with their family experience, past and current living circumstances, alcohol and drug abuse, and lack of adherence to a treatment program. Elimination of all serious mental illness at best would lower the violence rate by about 3 to 5%. Although this percentage is not to be ignored, the intense focus on such a small percentage of the problem detracts from the vast majority of the violence pie – the other 96%. And, recall that one third of violence risk is accounted for the alcohol and substance abuse.

Should we be putting our tax money, legislative, and policy efforts into registering the mentally ill, forcing therapists to report their clients to the police, and further stigmatizing and demonizing them? Should we allow lobbing efforts to prevail that maintain the status quo such as that promulgated by the NRA?

When a CDC study found that having a gun in the home, tripled the chances that a family member would get shot, the NRA stepped in. An Arkansas representative, Jay Dickey added language to a 1996 federal law that barred the CDC from conducting research that might be used ”to advocate or promote gun control.” We are fortunate that President Obama recently instructed the CDC to resume studying causes and prevention of gun violence. [Scientific American (editors), March 2013 issue, page 10.
]

Where should we be putting our money and efforts to reduce violence?

Here are my data based suggestions for combating violence of all kinds:

•    Fund more violence research, particularly domestic violence, gun violence, and how these co-occur,

•    Develop more treatment and prevention programs for alcohol and substance abuse, mental illness, and dual diagnosis of mental illness and substance abuse,

•       Enhance education of the public about the nature of mental illness, its causes and treatments, with a focus on reducing its social stigma,

•    Examine social policies that produce income inequality and other risk factors for violence that result from poverty and homeless.

Originally posted to RonK on Wed Mar 13, 2013 at 10:53 AM PDT.

Also republished by J Town, Shut Down the NRA, Mental Health Awareness, and Community Spotlight.

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Comment Preferences

  •  Republished to Mental Health Awareness nt (9+ / 0-)

    "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

    by second gen on Wed Mar 13, 2013 at 11:30:12 AM PDT

  •  wasn't it st ronnie who closed down the mental (7+ / 0-)

    health facilities back in the 80s? his (& the r's) idea of treatment for the mentally ill was to turn them out into the streets & now they're a convenient punching bag for the nra/rw to blame for all the senseless gun violence in the us.

    i don't understand why ann coulter, et al, blame mentally ill americans for using guns to kill people. it sounds like american exceptionalism at work to me. every country has its mentally ill but ours are apparently more capable of violence than anyone else's. usa! usa!

    •  No, it wasn't. (6+ / 0-)

      The process was well under way by the mid-60's.

      ...And it was mostly a liberal idea, a reaction to the (truely) deplorable state of mental health institutions at the time.

      Unintended consequence.

      •  Yes, it was the Kennedy Community Mental Health (6+ / 0-)

        act of the early 1960s that started with a shift of emphasis from the institutions to the community. Then they failed to fund the community health centers and then there was nothing. A real unintended consequence, the effects of which we are still feeling 50 years later.

        "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

        by RonK on Wed Mar 13, 2013 at 02:22:30 PM PDT

        [ Parent ]

        •  Actually the problem then wasn't funding (4+ / 0-)

          so much as the fact that, given the extreme stigma attached to mental illness (much more than at present), no one wanted a community mental health facility in their community. More than anything, NIMBY destroyed the attempt to create humane, community-based mental health care.

          "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

          by Alice in Florida on Wed Mar 13, 2013 at 05:43:17 PM PDT

          [ Parent ]

          •  Yes the NIMBY was an issue. But many (1+ / 0-)
            Recommended by:
            princesspat

            communities built centers that were funded  initially by the feds but then the communities were supposed to begin picking up the tab for the facilities and staff. The states, in my expereince did not step up as they were expected to.   All of this was of course related to the stigma issue and still is.

            Interestingly, our CMHC was built outside of town in the early 1970s. It is now quite in town as the community has grown. It is very busy but seriously under staffed.

            "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

            by RonK on Wed Mar 13, 2013 at 06:40:45 PM PDT

            [ Parent ]

            •  Reagan also had a hand. (5+ / 0-)

              The Mental Health Systems Act, signed by President Carter in 1980, was supposed to fund a nationwide network of CMHCs, many of them sharing facilities with FQHCs (primary care clinics). But one of the first things the Reagan administration did was repeal it and replace it with block grants to the states. The block grants were given out with no guidance whatsoever; many states simply used them to maintain existing inpatient facilities. The crucial second step of deinstitutionalization, which was to create the appropriate outpatient facilities, never happened because the MHSA never took effect.

              •  Not in any way to minimize the issue (0+ / 0-)

                I think the biggest mental issue in America is the mental illness of legislators who vote to deprive the hungry of food, the ill of medical care and sending the out of work to fight wars for corporations.  The republican't party is an illustration of pervasive mental illness.  In fact, we are not allowed to talk about the republican't rampant mental illness and what it has done, is doing and wants to do to all American people and our institutions.  Cure republican't mental illness and all issues are resolvable. There is not a single problem in America that can't be dealt w/if we would be allowed to speak openly of republican't mental illness and have it addressed in public.

                Don't believe everything you think.

                by BrianParker14 on Wed Mar 13, 2013 at 10:48:30 PM PDT

                [ Parent ]

      •  thanks for the info. e/m (4+ / 0-)
    •  It wasn't that he closed down (3+ / 0-)
      Recommended by:
      princesspat, RonK, tytalus

      the institutions. His contribution to the mess was to replace planned federally funded outpatient clinics with block grants to the states, handed out with no requirements for any specific use and not even any guidance whatsoever.

      •  Right, it was the states that closed them down. (3+ / 0-)
        Recommended by:
        princesspat, RJDixon74135, tytalus

        They simply did not pick up the ball and do the rest of the job in community. They probably felt they had free money. Again, at the state level, social services and mental health have gotten the short end of the stick.

        "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

        by RonK on Wed Mar 13, 2013 at 07:51:54 PM PDT

        [ Parent ]

  •  I think a lot of the focus on the mentally ill (10+ / 0-)

    is because the public is upset that there is seemingly no way to curtail mass shootings. Despite the fact that statistically they are extremely rare.

    Back when I used to comment on these issues, (I don't anymore because of too much flaming) I used to also say we need much more work on reducing poverty, income inequality, as well as access to all sorts of health care, the causes of most homicide.

    I'd also really like to see an end to discrimination against the mentally ill. Many people have fairly severe but manageable mental health issues and not only are they contributing members of society but great people too. Yet they have a very difficult time even getting a job.

    How big is your personal carbon footprint?

    by ban nock on Wed Mar 13, 2013 at 01:33:41 PM PDT

    •  The vulnerability..... (6+ / 0-)

      .....of  mentally ill young adults is heartbreaking to me. I keep seeing the face of a friend of mine as she said ...." My son is in jail, but he's safer there than living with his roommates." He had "outgrown" treatment options available to children and had reached an age when his parents could no longer make him stay home. So he was on his own, with compromised coping skills in a hard world.

      Love is the lasting legacy of our lives

      by princesspat on Wed Mar 13, 2013 at 02:29:38 PM PDT

      [ Parent ]

    •  You are correct about both matters. The public (5+ / 0-)

      responds to the  media hype which makes it look like these mass killings are the only killing going on, which they are not and mentally ill are an identifiable group that they can blame. Also, these mass  killings seem so inexplicable they assume that the shooters must be mentally ill.

      As noted in my diary, income inequality and all it represents is a significant part of violence of all kinds.

      "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

      by RonK on Wed Mar 13, 2013 at 02:31:57 PM PDT

      [ Parent ]

      •  I have to plead guilty here, RonK (3+ / 0-)
        Recommended by:
        princesspat, RonK, Cornbread Maxi
        Also, these mass  killings seem so inexplicable they assume that the shooters must be mentally ill.
        I'm not a mental health professional, but I helped finance  graduate school (in a completely different field) teaching adolescent "offenders" who were  court ordered into a locked ward inside a mental hospital.  (One of those "privatized" programs at public expense, but that's a different story.)  I liked every single one of the kids I taught, so for that and other reasons, I've wondered quite a bit about this part of the human condition.  I admit that I assume that anyone who commits a mass killing is mentally ill. Do you think that my (unprofessional) definition of what constitutes mental illness is overly board? Where do you think I'm going wrong?
        •  It is natural to seek a compassionate explaination (4+ / 0-)

          for horrible deeds, and equally natural to want to define the perpetrators as "other", in this case as mentally ill.  However, a diagnosis should only be made by a clinically trained professional who has evaluated the individual in question, and in accordance with current scientific standards (e.g., Diagnostic and Statistical Manual of Mental Disorders--DSM).  A great way to further your understanding of the way mental illnesses are diagnosed is to spend some time poking through the DSM.  

          Socialist? I do not think that word means what you think it means.

          by Kimbeaux on Thu Mar 14, 2013 at 08:19:43 AM PDT

          [ Parent ]

          •  Excellent point Kimbeaux. (2+ / 0-)
            Recommended by:
            princesspat, Cornbread Maxi

            We need to be careful with diagnoses as it is easy to get into name calling. And frankly, naming is not the same as explaining.

            So, even if we do diagnose someone it only tells us who but not why they might have done something.

            "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

            by RonK on Thu Mar 14, 2013 at 09:19:07 AM PDT

            [ Parent ]

        •  Excellent question RJDixon, (2+ / 0-)
          Recommended by:
          princesspat, Cornbread Maxi

          A technical answer would include what I noted in the diary that using the term "seriously mentally ill" we include major mental disroders that would typically include people with psychoses such as schizophrenia, bipolar, and severe major depression, along with a few others. This does not include most of the 300 or so diasgnoses in the DSM.

          Now, people who commit these heinuos acts are not without problems and some might want to call them sick, but they are not always seriously mentally ill.

          So the issue comes down to what kind of mental or behavioral disosrder one mght have. Antisocial personality disorder - psychopath, is a disorder but would not be included in the broad category of major mental disorder.

          I hope this helps a bit. i know it is not a totally satisfying answer.

          "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

          by RonK on Thu Mar 14, 2013 at 08:54:49 AM PDT

          [ Parent ]

    •  You are so right! nt (2+ / 0-)
      Recommended by:
      RonK, princesspat
    •  ban nock, from what I see on television, the (4+ / 0-)
      Recommended by:
      gramofsam1, ban nock, princesspat, RonK

      NRA is very intentionally working to scapegoat people with mental illness for gun violence in our culture, as if the discrimination hurdles weren't already high enough.

      •  I don't watch much TV, and I don't read or look at (4+ / 0-)

        much NRA advertising. But from my view most if not all mass shootings like Aurora and CT are done by people with mental health issues, fairly severe ones.

        As the diarist points out people who have these issues are a very small portion of the people who do suffer mental illness, and the major portion of gun homicide is done by people without these issues.

        There are no easy answers or ways to prevent mass shootings, or none I've heard anyone mention. The only effective measure I can see is to offer lots of free health care and support. No one wants to do that, especially the support part. Like free protected living arrangements.

        Of course just for saying this if anyone reads this like if it were a recommended diary I'd be accused of repeating NRA talking points etc etc.

        I think polarization has caused as much harm as anything.

        How big is your personal carbon footprint?

        by ban nock on Thu Mar 14, 2013 at 08:02:57 AM PDT

        [ Parent ]

        •  Excellent points. (3+ / 0-)
          Recommended by:
          princesspat, ban nock, Cornbread Maxi

          I have to ask, how many odd and mentally ill people are there in your community?  At least 2% of your community has a serious mental diagnosis. And how many of them have committed a serious violent act? very few I am sure.

          "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

          by RonK on Thu Mar 14, 2013 at 09:02:50 AM PDT

          [ Parent ]

      •  Yes, by the NRA focusing on treatment, it (2+ / 0-)
        Recommended by:
        princesspat, Cornbread Maxi

        implies that it is all the mentally ill doing the killing. I makes it sound like they are being compassionate but they are really scapegoating.  Thanks to Wayne LaPierre.

        "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

        by RonK on Thu Mar 14, 2013 at 09:21:50 AM PDT

        [ Parent ]

  •  Excellent diary, sharing to FB (4+ / 0-)

    YES WE DID -- AGAIN. FOUR MORE YEARS.

    by raincrow on Wed Mar 13, 2013 at 02:40:25 PM PDT

  •  ...great one... (3+ / 0-)
    Recommended by:
    RonK, princesspat, alice kleeman

    Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences.

    by paradise50 on Wed Mar 13, 2013 at 03:49:38 PM PDT

  •  Mentally ill without guns? Dangerous to self, (4+ / 0-)
    Recommended by:
    princesspat, RonK, LilithGardener, tytalus

    far more than to anyone else.

    Mentally ill with access to guns? Riskier, but still far more risk of suicide than homicide.

    History of violent behavior, petty crime, or domestic abuse plus guns? Now we're talking extremely dangerous to everyone around.

    •  You are on track Ralphdog. Lay out all the (3+ / 0-)
      Recommended by:
      princesspat, LilithGardener, tytalus

      predictors and include guns, substance abuse, and an emotional family situation,  make it possible and lo and behold, you have tragedy. With or without mental illness.

      "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

      by RonK on Wed Mar 13, 2013 at 06:14:22 PM PDT

      [ Parent ]

  •  Well done diary, and badly needed! (3+ / 0-)
    Recommended by:
    RonK, princesspat, Cornbread Maxi

    It had an interesting neighbor in the recommended list: "Mental Illness and Violence" came right after "I Read Paul Ryan's Budget".

    Note that there's an opportunity here to point out the limits of reasoning from statistics. "11 times more likely to be victims of violent crime than the general population": that's horrifying from a human point of view, of course, but let me make a nerdy point.

    Suppose someone did a neighborhood by neighborhood study of mental illness and violence. A neighborhood where people are often victimized is by definition a high-crime neighborhood. The study would therefore find a correlation between the prevalence of mental illness and the violent crime rate.

    That kind of thing is the reason we need to be so careful drawing conclusions from correlations.

    Freedom isn't free. Patriots pay taxes.

    by Dogs are fuzzy on Wed Mar 13, 2013 at 08:10:13 PM PDT

    •  Yes, you are correct, but this is the very thing (1+ / 0-)
      Recommended by:
      princesspat

      that the MacArthur studies took into account. Their conclusion, as noted in the diary was that  taking the specific community into account, the violence rate of the mentally ill was no different from that of the community in general.
      Are you saying/asking something else?

      "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

      by RonK on Wed Mar 13, 2013 at 09:06:06 PM PDT

      [ Parent ]

      •  I always find it amazing (3+ / 0-)
        Recommended by:
        princesspat, RonK, Cornbread Maxi

        how very few families escape without knowing someone in their family or extended family who suffers from mental illness; and yet, the ignorance surrounding mental illness, and the stigma that holds back real information, and worst, real help, is still so prevalent. Please keep on writing your diaries and informing us about such important studies!!

        "You can safely assume you've created God in your own image when it turns out that God hates all the same people you do." Anne Lamott

        by rsr on Thu Mar 14, 2013 at 09:11:20 AM PDT

        [ Parent ]

        •  Thanks for your comment rsr. you are correct in (2+ / 0-)
          Recommended by:
          princesspat, Cornbread Maxi

          pointing out the prevalence of SMI in families but the stigma and shame remain. Probably the worst problem is that it keeps the person and family from seeking treatment until it is far advanced and in some cases, too late.

          "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

          by RonK on Thu Mar 14, 2013 at 09:40:24 AM PDT

          [ Parent ]

  •  I wish a panel discussion were possible. (3+ / 0-)
    Recommended by:
    princesspat, RonK, Cornbread Maxi

    This forum has a lot of reach, in national terms.  There are many issues from various perspectives that ought to be more fully explored.  So, please, more diaries like this!

    My experience comes from being a family member.  My brother had his first acute manic episode in what was later diagnosed as Bipolar Disorder, in his sophomore year in high school.  

    The family had no idea what was happening and the school counselors and the psychiatric referrals weren't great either.  

    That first episode happened in 1970.  At that time most of the kids thought it was funny that he would come to school high on LSD, which they were sure was what was going on.  

    Understanding hasn't much improved over the years.  He died at the age of 56, beating the average life expectancy by a year, a couple of years ago.  Looking back on the decades, there are several lessons.

    Schools must have better resources and access to better trained professionals.  Prevention of possible violence, by catching the Adam Lanzas of the world early might be a benefit, but the purpose of education for all of us needs to be the priority.  We all learn how to cope with life as a human being and as a member of a civilized society.  Mental illness is compounded by the isolation that impairs the development of social skills as well as intellectual capability.  

    Over the 40 years there were about 3 episodes when the question of danger arose.  He called the bomb squad once, because he was paranoid about a package that came in the mail - from mom.  For a while he was into target practice with a pistol.  That didn't seem like a good idea and so the gun was removed from the house.  One time, he decided that he had the authority to decide that green lights meant "stop" and red lights meant "go".  Luckily, in the wee hours, there wasn't much traffic went he went driving around.  

    The thing that makes mental illness a tough issue is that you can't trust the judgement of someone who loses the ability to track reality from time to time.  You just don't know what this will mean.  

    As a family member, I think the Treatment Advocacy Center's pursuit of involuntary commitment laws that make it easier to get people who need treatment, into mandatory treatment, is actually a very good idea.  There is nothing worse than not being able to do anything except wait until the time comes when the phone rings and it is the police.  That is not the way to provide mercy and care.  

    I am glad that the recent spate of shootings has caused there to be more discussion.  One could wish it were more intelligent more often.  But at least it is a discussion.

    I hope that everyone who has anything at all to contribute can find a way to promote more and better discussion wherever possible.

    For too long, this subject has been one that most people find it best to avoid altogether.  This is the first time I have seen in the past several decades when public discussion has opened up much at all.  

    hope that the idiots who have no constructive and creative solutions but only look to tear down will not win the day.

    by Stuart Heady on Thu Mar 14, 2013 at 10:24:05 AM PDT

    •  Thank you for your illuminating comments. (2+ / 0-)
      Recommended by:
      princesspat, Cornbread Maxi

      I agree with you on all points, particularly on the issue of involuntary committment. The pendulum swung from being easy to lock up an embarrassing family member to being unable to get help for those in serious need until they do somehthing dangerous or illegal.

      The jail has become the defacto mental hospital nowadays. It is the first stop for so many of the mentally ill. The number of hospital beds for the mentally ill is now so few that many hospitals are using beds in the emergency rooms to house mental patients. This is a travesty to be sure. And a statement of social priorities, or at least legislative priorities along with an uninformed public.

      I have a couple more diaries in mind on issues of mental illnenss and will look forward to further discussion on DKos.

      "There is nothing - absolutely nothing - half so much worth doing as simply messing about in boats ..." - Kenneth Grahame -

      by RonK on Thu Mar 14, 2013 at 11:01:27 AM PDT

      [ Parent ]

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