In the wake of the tragedy at Sandy Hook Elementary, many are discussing the status of mental health care in the United States.
One of the first to draw attention to the matter was Liza Long, who wrote the article “I am Adam Lanza’s Mother.” In the article, Long describes her own struggles with her mentally-ill and often violent teenage son. She laments that she was advised to have her child arrested so that there would be a record of his violence and that this would somehow help in his treatment because the government will not step in until there is proof that the patient is violent. Her experience may shed some light on evidence cited by the National Institute of Corrections that “people with mental illnesses are overrepresented in probation and parole populations.” So, the question remains. Is mental illness to blame for the slew of violent crimes we have seen as of late?
Despite what the majority of media outlets seem to want the public to believe, evidence and research have determined that mental disorders are not to blame for violence. Many statistics regarding the prevalence of violent behavior in the mentally ill suffer from a sampling bias. Many of the statistics are drawn from patients who have already been arrested or from patients in care facilities. The majority of people with mental disorders are not in jail or hospitals, but those who are violent are more likely to be. While rates of violence amongst these populations might be higher, it is not representative of all people who are mentally ill. This would explain why the mentally ill are over-represented in prisons and why psychiatric ward doctors report higher rates of attacks by patients.
Variables such as drugs and alcohol seem to be a major cause of violent behavior. Heather Stuart, in her paper, “Violence and mental illness: an overview,” explains that not only is mental illness not to blame for violent acts, but that the mentally ill are actually much more likely to be victims of violence than the general population. This, Stuart claims, “may predispose the mentally ill to react violently when provoked.” Stuart also cites the MacArthur Violence Risk Assessment Study, which found that those with mental disorders and no history of substance abuse were just as unlikely to commit a violent act as control subjects. She states that approximately seventy percent of violent crimes committed by those with mental disorders also involved substance abuse.
Another strong indicator of violent behavior is a history of violent behavior. If someone has been violent in the past, there is a strong possibility that they will be violent again. According to the January 2011 Harvard Mental Health Letter, a history of violence “may be the largest single predictor of future violence.”
There is still some disagreement over the best method of treatment for the prevention of violence. The Harvard Mental Health Letter suggests that because the statistics for violence in some forms of mental disorders are slightly higher than control statistics, keeping patients on a drug regimen might help prevent violence. However, in “Dispelling the Myth of Violence and Mental Illness” by John M. Grohol, it is noted that many studies of the effectiveness of treatment have skewed results because it compares self-reported statistics of violence right before treatment until a few years later. Violence may well have been the cause of treatment in the first place and thus will be more likely right before treatment. The article also notes that statistics are not compared to a control group where violent subjects did not receive treatment. Because of conflicting reports, it becomes difficult to determine the best course of action to prevent violence and whether or not people should be forced to receive treatment for mental illness.
In a letter to Cato Unbound, DJ Jaffe, the Executive Director of MentalIllnessPolicy.Org argues that Libertarians should have no qualms with involuntary commitment or forcing a patient to receive treatment. He argues that subjects who are trapped in their own mind and delusions are not truly free and that forcing them to receive treatment will actually allow them to live their lives more freely.
However, this assumes that the subject is happier after receiving treatment. As previously discussed, there is little to fear in terms of violence from those with mental disorders, so forcing a subject to receive treatment will not necessarily protect those around them. If it does become necessary for a subject to receive treatment, it is important to explore outpatient options. In California, Laura’s Law allows for an individual to be forced to take medication or to receive outpatient treatment. Laura’s Law allows for more freedom in the individual’s life than inpatient treatment or incarceration, so it is easier for the liberty-minded to accept and provides actual care rather than just punishment.
In short, there is no reason for society to fear that individuals with mental disorders will become violent. Statistics seem to indicate that those who are mentally ill are only slightly more likely to be violent than matched control subjects and even those statistics seem to be biased. When necessary, it is important to explore outpatient options before considering incarceration or forced inpatient treatment.