Mental Illness Plays Only ‘Limited’ Role in Mass Violence: Paper

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Memorial for one of the victims of the El Paso shooting. Still courtesy PBS

Mental illness plays an “important but limited role” in mass violence, according to a paper prepared for the National Council for Behavioral Health by the Medical Director Institute (MDI).

“While there is a modest link between mental illness and violence, there is no basis for the public’s generalized fear of people with mental illness,” said the paper, which summed up a recent panel of experts on mass violence convened by the MDI.

“Having a psychiatric diagnosis is neither necessary nor sufficient as a risk factor for committing an act of mass violence.”

The paper noted that mass violence is “rare,” and has accounted for less than two-tenths of one percent of homicides in the U.S. between 2000 and 2016, even though the U.S. stands out among other advanced countries because of the frequent use of guns by violence perpetrators.

Efforts to tie such incidents to mental illness are understandable but misleading, the paper said.

“Incidents of mass violence — especially those that appear to be senseless, random acts directed at strangers in public places — are so terrifying and traumatic that the community responds defensively and demands an explanation,” said the paper.

“After such events, political leaders often invoke mental illness as the reason for mass violence, a narrative that resonates with the widespread public belief that mentally ill individuals in general pose a danger to others.

“Since it is difficult to imagine that a mentally healthy person would deliberately kill multiple strangers, it is commonly assumed that all perpetrators of mass violence must be mentally ill.”

To the extent that mental health issues play any role in shootings, the best way to address such issues is through a “public health model of prevention,” the paper said.

The model includes three components:

  • A public education campaign to identify people of concern;
  • Measures to assess and intervene with people with specified warnings signs, who have access to weapons capable of inflicting mass casualties;
  • Measures to “contain, assess and intervene” with people who have past histories of threatened or actual significant violence.

Addressing mass violence requires a multi-pronged strategy in which mental health counseling only plays a part, said the paper.

According to speakers at the panel, perpetrators of mass violence are mostly male, who often feel victimized, or hold resentments related to school, work, or interpersonal relationships.

According to the paper, proper threat assessment in which authorities identify persons on the “pathway to violence” is a key first step.

Multi-disciplinary groups, including primary care providers, behavioral health providers, law enforcement, and courts, need to collaborate to identify and manage threats, the paper said.

The panelists warned that some of the immediate reactions to mass violence incidents like school shootings are counter-productive and result in “ill-considered policy decisions.”

“One example is the use of zero-tolerance policies in schools,” the paper said.

“The result is that students are suspended for a variety of minor misbehaviors, sometimes unnecessarily, potentially creating isolation and resentment that can lead to more and more serious, problematic behaviors.”

Similarly “excessive security measures,” such as bulletproof building entrances, electronic door locks, and school-shooter drills, can be “psychologically traumatizing.”

“Though some safety drills are warranted, those that evoke fear and create trauma do more harm than good,” the paper said.

The 20-person panel, which was commissioned in 2015, reported its findings this month.

The National Council for Behavioral Health is the largest organization of mental health and addiction treatment programs in the U.S.

Read the full paper here.