Statistics Don’t Tell The Whole Story About Mental Illness and Violence

Keith Vidal picture courtesy of CNN report

This blog post is dedicated to the memory of Keith Vidal, an eighteen-year-old man who lived with schizophrenia, and to his family who loved, cared and supported him. In his honor, and the many others who unfortunately experienced similar fates, may we all continue to work toward bringing awareness and understanding about mental illness.

The following is a link to the CNN news story about his tragic death:

http://www.cnn.com/2014/01/07/justice/north-carolina-teen-killed/index.html?hpt=hp_t1

♦ 

Finally, in some pockets of our society real discussions about mental health are being conducted, but as many who have a loved one living with a serious mental illness know, we’re not quite there. Nowhere close. And whether these discussions result in effective laws and policies thoughtfully addressing this highlighted issue is another matter. It’s a sad reality that violent tragedies, such as Keith Vidal’s unnecessary death and mass shootings of the innocent, were required to bring the issue forth.

And still, there remains a mental illness stigma and the myth that mental illness and violence go hand in hand. In an effort to address the insidious stigma and clarify the mental illness connection, advocates cite statistics illustrating that not all individuals living with a serious mental illness (SMI) have violent tendencies. In a National Institute of Health blog post of January 11, 2011, NIMH Director Thomas Insel clarified thusly:

People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further. But mental illness contributes very little to the overall rate of violence in the community. 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… those with SMI are 11 times more likely to be victims of violent crime than the general population.

Mr. Insel goes on to explain that death by suicide is “the 10^th leading cause of death in the United States” and that, while it is impossible know the specifics of each of these deaths, “it is safe to say that unrecognized, untreated mental illness is a leading culprit.”

Mr. Insel clarifies the mental illness – violence connection. But he barely touches upon the myriad of ways a person with SMI will unknowingly endanger oneself, probably because unless you have a loved one living with SMI, it is difficult to comprehend the depths of poor judgment a person can have. We are not referring to comically bad life choices, but rather decisions with painful and/ or fatal consequences. A person experiencing psychosis is incapable of rational thought and is victimized in varying degrees, the statistics for which are hard to calculate. Behavior and poor judgment associated with SMI make one vulnerable to manipulation and abuse by others, self-abuse (unknowing or intentional), and secondary physical illness.

We interviewed several parents who recounted stories about their very ill child who, while suffering psychosis, desires to wander homeless. Maika’s son, Riley, often went off medication and binge drank, during which time he’d prefer to live among the homeless. A “don’t hem me in” mode would take over. During these incidences Maika searched for him in vain, worried he would encounter law enforcement that may misinterpret his psychotic behaviors. She understands the reality that all too often a mentally unstable individual cannot process directives shouted by a police officer and instead either runs away or moves in a manner that suggests he is brandishing a weapon. Too often, these encounters lead to a fatality.

Annie recounts similar stories of her son’s wanderings. Sometimes he’d call for help by which time, he’d be experiencing severe psychosis; he’d be cold, hungry, and his feet would be so abused from walking they’d be swollen and infected. Delusional thinking led Annie’s son to commit a series of breaking and entering of local businesses. Annie doesn’t justify her son’s actions and in fact, she stepped up to replace the business owner’s door that he’d damaged during a break in. In that incident, once he got into the building he immediately realized he didn’t know what he was doing and ran off. Annie worries that police will misjudge her son’s behavior as violent with intent to harm others, and will respond by shooting him. Just such an incident occurred near her home when a psychotic young man was fatally shot by police. This young man was living with Annie’s son at the time of the incident. She is grateful, she says, that her son is small in stature. “It makes him appear less scary.”

The irony is that loved ones are often unable to get help from law enforcement to remove a clearly psychotic individual from the street and commit him into treatment. 

The irony is that loved ones are often unable to get help from law enforcement to remove a clearly psychotic individual from the street and commit him into treatment. To enforce hospitalization, which would stabilize her son’s mental health and keep him safe, Maika is required to prove to law enforcement that her son “is a danger to himself or others.” Unless he verbalizes that he is experiencing suicidal ideation or attacks another person she cannot make the case. And yet, longer a person experiences untreated psychosis, the more damage is done to one’s brain.

Still, vulnerability comes in other forms. A father we interviewed talked about frightening voices that invaded his daughter’s mind, and sometimes gave her instructions to do harm to her loved ones. Another mother explained that her daughter’s delusions made her feel the need to deliver food to homeless people in the middle of the night in an unlit park that happened to be a cell reception hole and a gathering place for the homeless and drug users. There was no way to convince her adult daughter otherwise; it isn’t illegal but it was clearly bad judgment.

And there are still more dangers in the vulnerability of those who live with SMI. The nature of SMI is such that rationality is limited and paranoia, distrust, fear, anxiety, and delusions are in abundance. Some individuals with SMI latch onto irrational beliefs or adopt a philosophy or religion to an unreasonable degree; overzealous religiosity is not uncommon for individuals experiencing psychosis. Shortly after being released from a psychiatry ward, a young man in his twenties and still vulnerable, began to take advice from members of a cult who convinced him to lower his medications, drink only distilled water and his own urine. Still in a cycle of hypomania, his paranoia overcame him and he began to believe the cult members were out to kill him. Fortunately, he received treatment and was stabilized.

In all of these cases, what has saved these individuals who were suffering from poor judgment or full-blown psychosis is intervention by a loved one—in these cases a parent—and, or luck. Even with a parent advocating, it is a challenge to secure intervention for one’s child early enough and long enough, which is a whole other facet to the mental illness discussion.

When we talk about how to prevent the tragedies that are occurring all over the country all too often because a person with SMI was not heard, not helped, or somehow got access to an AK47, let us not forget the many self-inflicted tragedies happening every day. We don’t hear about most of these incidences in the media. What happened to Mr. Vidal happens every day. Most tragedies are quietly mourned. The victims of these incidents are the loved ones who desperately wish to protect their own too, in a system that often fails them.

Thomas Insel offers hope, though. Early intervention can be all the difference for some individuals living with mental illness. Discussions about SMI are about proper law-enforcement training, stemming violence, and creating more safe and compassionate society for all of us. Let’s keep talking.

Mr. Insel’s blog entry that we have cited can be found at: http://www.nimh.nih.gov/about/director/2011/understanding-severe-mental-illness.shtml) Thomas Insel, NIMH Director, January 11, 2011

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