The political rhetoric that blames people with mental illness for spasms of mass violence seems to be seeping into the national psyche.
Americans increasingly see people with schizophrenia or major depression as a threat not only to themselves but to others, new research reveals. This caution extends even to those who have difficulty coping with everyday life but whose symptoms fall far short of a psychiatric diagnosis.
This growing view – that people with mental disorders can be a threat to public safety – seems to be generating greater openness to the expansion of mental health treatment. But it is specifically deepening support for laws that require people with psychiatric symptoms to receive treatment, whether they want it or not.
These feelings, and how they have changed over time, come from surveys conducted in 1996, 2006, and 2018 that polled Americans' attitudes about mental health issues and their connection to public safety. The 2018 survey followed shortly after a series of high profile mass shootings in Nevada, Texas and Florida that killed 101 lives.
As these incidents have increased in recent years, gun rights advocates and their political allies have attributed violence to people with mental illness. They called for measures to wipe out the mentally ill and prevent them from owning weapons.
Responding to consecutive shootings this summer in El Paso and Dayton, Ohio, President Trump sought to shift the political focus from the gun restrictions sought by many Democrats to the attackers' mental state.
"Mental illness and hate pull the trigger," said Trump. "It's not the weapon."
He suggested that the total closure of psychiatric hospitals in the 1960s and 1970s was a mistake and that the United States should reopen these institutions to prevent mass violence. "Let's get mentally dangerous and dangerous people off the streets so we don't have to worry about them so much," he said. "A big problem."
The evidence for changing attitudes came from General Social Research, a monitor of American beliefs and behaviors conducted by the University of Chicago. In the survey, respondents responded to a brief description of an individual whose behavior typified one of three mental disorders – schizophrenia, major depressive disorder, or alcohol dependence – or a fourth person who has concerns and challenges but is "doing very well". .
Survey participants were asked to judge how likely they would be injured or inflicted harm on others. They were asked if they supported laws that would require the person described to take medicine, consult a doctor or undergo hospitalization for his condition.
In 2018, approximately 70% of respondents thought people likely to be diagnosed with schizophrenia as a potential danger to others. In 1996, approximately 57% held this opinion, as did about 60% of those surveyed in 2006.
Surveys also revealed that 59% of Americans in 2018 supported laws requiring hospitalization, even involuntary hospitalization, of those who meet the diagnostic criteria for schizophrenia. Less than half shared this view in 2006.
Approximately one-third of respondents in 2018 considered people with depression to be too or a little likely to cause harm to others. And 68% considered people with alcohol dependence to be dangerous to others; Support for laws to force an alcohol-dependent person to undergo some form of therapy ranged from 26% to 38%, depending on the treatment involved.
The results, compiled by Indiana University and Vanderbilt University sociologists and a University of Virginia psychologist, were published this week in the journal Health Affairs.
Jeffrey Lieberman, a Columbia University psychiatrist who studies violence, said attitudes expressed in research are not difficult to understand.
"People want simple solutions: they want to be able to explain things perfectly," he said. "This is a convenient way to avoid less acceptable solutions such as gun control."
Lieberman said he supports keeping many weapons with mental illness and believes the laws have made it too difficult for civilians to commit themselves to serious mental illness. But comprehensive solutions distract the thorniest and most basic problems that need to be fixed, he said.
"The root cause is a failed healthcare system," he said. "People don't get treatment for mental illness."
“People with mental illness are not treated much in this country. They are criminalized and marginalized and the treatment really is not up to it, ”said Rosenberg. "It's a godsend we're having this discussion. Anything that leads us to discuss mental illness is a good thing except something that is stigmatizing."
About 19% of US adults – close to 47 million people in 2017 – suffer from some form of mental illness. Severe mental illness, which significantly limits a person's ability to navigate daily demands, affects approximately 4.5% of the adult population, or 11.2 million Americans.
Most mental health lawyers have contested the charge that people with psychiatric problems are responsible for the dramatic increase in mass violence in the United States. Search for FBI experts and elsewhere demonstrates no more than one room Those who have attempted or carried out mass shootings in recent years can be considered mentally ill. In fact, people with mental disorders are much more likely to be victims of violence than the perpetrators.
At the same time, lawyers welcomed the call to make mental health treatment more widely accessible and to keep the weapons of people more likely to be injured than others.
Contradictory messages seem to be moving public opinion. More Americans fear that mental illness is a major contributor to violence, and more seem to believe that treatment – even if coerced – could improve public safety, the new study suggests.
This belief is not supported by research evidence, say the study authors.
"The link between violence and mental illness has been scientifically documented as weak at best for at least three decades," they wrote.
They cited a recent Review Even if we had a cure for serious mental illness that completely eliminated active psychotic and mood disorders, the problem of interpersonal violence in the population would be reduced by only about 4%, while 96% of violent acts would be reduced. still occur. "
Such calculations take into account the mass shootings, with the daily beatings of deaths and injuries from domestic disputes, gang activity and general crime in the United States. In this broader context, people with mental illness are a tiny factor.
But experts acknowledge that, at least in recent years, those with severe mental illness have been responsible for a considerable minority of mass shooting cases. The other two major categories of mass shooters – those driven by radical ideological beliefs and offended, disgruntled or disgruntled workers, students or domestic partners – are harder to identify and even harder to arrest and stop when anger boils over. . .
"What we know from research on mass casualty events is that most of them are done by people who are in a point of personal crisis," he said. Marisa Randazzo, former US Secret Service research psychologist and now chief executive of Sigma Threat Management Associates. “Most of them are actively suicidal – and can even expect to be killed by police when they engage in a violent attack. But being in personal or emotional crisis – or even suicide – is not the same as having a mental illness. "
This fact – that many who commit acts of mass violence are disturbed but not ill – presents an opportunity for colleagues, co-workers and law enforcement officials. This means that they can intervene early, before a person's hurt becomes a desire to harm themselves and others.
"We know a lot about helping someone who is in personal or even suicidal crisis," Randazzo said. "Sometimes this may need to involve an involuntary psychological or psychiatric assessment, but it can often be done through voluntary care."
Lieberman called this a "mental health first aid" strategy. More Americans need to practice it in their homes, schools and workplaces, he said.
"If someone faints, starts to choke or has a seizure, people rush to help," he said. "If someone is acting weird, people don't say anything."
When a person's behavior seems strange, asking what is going on and offering help can seem intrusive, Lieberman said. But it has a small chance of stopping violence on the way and a very good chance of comforting a human in distress.
"Even if you have a high rate of false positives, what harm could you be causing?" He asked. "You are trying to provide some expression of interest, if not treatment, to someone in difficulty. You are saying, 'We would like to help.'"