In the hours after the horrific mass murder in El Paso on August 3rd, Texas’s Governor Greg Abbott suggested that “mental health is a large contributor” to violence. After a second shooting in Dayton, Ohio on August 4th, the President stated, “mental illness pulls the trigger.” Suggesting mental health is a causal factor in violence has become a common trope after our increasingly common mass shootings. The public, and the media, quickly follow, and mental illness is blamed. As a mental health provider, I should welcome calls for greater mental health access – I regularly come up against the limits of treatment availability and gaps in adequate coverage. However, it is for exactly this reason that it is incumbent on me to specify that mental illness is, in fact, NOT a large contributor to violence.
In fact, few people with mental health issues are violent. The most common mental disorders – depression and anxiety, for example – are not associated with violence. Research has repeatedly found that severe mental illness, including schizophrenia and bipolar disorder, does not predict future violence. A recent study of data from almost 40 years of research on the topic concluded that the risk was so low that, in order to prevent one stranger’s homicide, 35,000 patients with schizophrenia deemed to be at high risk of violence would need to be placed into individual treatment. In total, only about 3-5% of violence in the U.S. can be attributed to mental illness. In other words, even if the proportion of violence caused by mental disorders was prevented, approximately 96% of violence that currently occurs would continue.
Moreover, people experiencing mental illness are much more likely to be victims of violence. Though statistics vary, it is evident these persons are at much greater risk of being violently traumatized than the general population, and that this risk has increased over the last 40 years. It’s also probable that these crimes are less likely to be reported. Worse, the victimization and experiences of trauma perpetrated against people with mental illness contribute to worse mental health outcomes and symptom severity.
Lastly, mental illness is not an excuse for bad/aggressive/violent behavior. The two are not synonymous. The most recent estimates suggest 20% of adults in the U.S. have a diagnosable mental illness. Yet, these tens of millions of Americans are not full of hatred, racism, and hostility. Conflating mental illness with terrorism is inaccurate and impedes progress in either area.
Given the unlikelihood of mental illness predicting future violence, perpetuating the belief that people with mental disorders are dangerous is incredibly stigmatizing. Moreover, discrimination related to these baseless stereotypes prevents people who need care, and their families, from reaching out for help. It is possible to promote greater access to mental health care without reinforcing this bias. Focusing on mental illness, broadly, instead of discussing factors that are actually predictive of violence – such as substance use, childhood physical abuse, intimate partner violence, youth, male sex, access to weapons – prevents meaningful change. At a time when change is imperative, further scapegoating of mental health is unwarranted, counterproductive, and harmful.
Sarah Woods, PhD, LMFT-Supervisor is an Assistant Professor and Director of Behavioral Health in family medicine, based in Dallas, Texas. She is a families and health researcher emphasizing integrated behavioral health in primary care. This research dovetails with her focus on advocacy specific to mental health access, especially for underserved populations.