The Trouble with Denying the Violence Connection to Serious Mental Illness

In the wake of recent tragedies our Nation is reeling between the surging waves of gun control rhetoric and solutions to our broken mental illness treatment system. Emotions are looming large while political narratives vie for our attention. For more than two years now Representative Tim Murphy (PA) has been tirelessly working to gain support for The Helping Families in Mental Health Crisis Act. Advocates have been at work hoping to spark the attention of a seemingly deaf country to hear the cries of families who have a loved with serious mental illnesses that include schizophrenia and bipolar with psychotic features. The particular focus of this bill is the smaller group of individuals with such a severe degree of illness that they have “anosognosia,” a medical condition where they do not recognize their illness or need for treatment. Speaker Paul Ryan mentioned the need to look at this bill and the issue of our broken system more closely in a 60 Minutes segment last week (watch it here). Now, in light of this most recent mass shooting in San Bernardino, California (which had nothing to do with mental illness) many advocates for the mentally ill are concerned about violence being publicly connected to serious mental illness as the media continues with its barrage of rhetoric. On the surface, this concern has warrant. I’ve been involved in several discussions of late where people are calling for the end of making any correlation between violence and serious mental illness. But here’s the problem I have with that request: it simply doesn’t involve the truth. Our society does not even recognize psychosis in schizophrenia and bipolar, for example, the way it does in advanced stage Parkinson’s Disease. Nor do we treat people with these illnesses with the same level of care. Most states in our country that do have involuntary treatment laws still require a “danger to self or others” standard. The disparity in available services between these two separate sets of diseases is stunning. Advocates bemoan the correlation of violence with the mentally ill yet our system requires it before treatment can be accessed, if at all, and by then it is often too late. Statistics are all over the place regarding mass shootings involving someone with mental illness. Yet a quieter, steady stream of tragedies involving violence occurs almost on a weekly basis now all across America. These stories rarely make national headlines, but we cannot ignore them any longer. Stigma is the culprit most lament. If we acknowledge that some severely mentally ill persons can become violent we run the risk of painting a broad brush over everyone with some form of mental illness. So we choose silence instead. I would argue that we create our own stigma by neglecting the sickest mentally ill with anosognosia and fostering a system of “care” that relies on dangerousness standards before treatment. For what other illness do we have to involve the criminal justice system on such a massive scale? If there is no violence correlation, then why does law enforcement need training in how to handle the mentally ill? Why are they even called out for crisis situations in the first place? No, to ignore the truth about violence is to ignore the truth about our neglect of the most seriously mentally ill. And that is the cruelest choice we could ever make.