After Tucson: rethinking mental illness and violence

Current Thinking

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Since the Tucson shooting earlier this month, calls for reform have filled the opinion sections of the country’s major newspapers and electronic media–reform of political rhetoric, reform of gun policy, and reform of America’s mental health care system. And there should be. When tragedy strikes, as it did in Tucson, there is a desire to take action to prevent such a tragedy from occurring again. Yet there is great risk in “reactive policy”public policy that rises from reaction, rather than research.

The danger inherent in reactive policy is particularly pronounced in the debate about the possible link between Jared Loughner’s likely mental illness and his alleged violent actions, and how public policy should account for it. Namely, there has been a lively dispute about reforming involuntary commitment laws in the days since the shooting. Many have called for easing these restrictions and making it easier to mandate treatment and hospitalization for individuals with mental illness, with the aim of keeping the public safe and getting people treatment who need it. Just as many people have spoken out against such changes on the premise that broader use of involuntary commitment violates basic human rights and that the necessary reform is to increase funding for mental health treatment systems. This debate is a deeply personal one for many people, with mental health advocates intimately affected by this issue arguing on both sides.

While in some cases the link between mental illness and violence is presumed without caveat, there are more nuanced discussions of the relationship between mental health and violent behavior that cite empirical research. It is heartening to see empirical studies cited in popular media; however too much of the debate is relying on research “sound bites,” using study findings in a piecemeal fashion to support positions on either side of the argument. For instance, some proponents of easing the commitment laws have asserted that “research shows” that mental illness increases one’s propensity to be violent. Some opponents of easing the laws, meanwhile, have claimed “research shows” that mental illness does not increase the likelihood of violence, but that substance abuse increases that likelihood. Neither statement is technically false, but both present a diluted picture of the research findings and fail to highlight the myriad caveats that complicate the relationship between mental illness and violence. Furthermore, many voices in this conversation have been quick to generalize, citing studies that focus on schizophrenia to support a policy that would apply to all individuals with mental illnesses, or using “substance abuse” as a blanket term to refer to illicit substances with widely differing effects. 

A more nuanced description of the research would explain that people with severe mental illnesses are more likely to be violent than individuals without mental illness, with the important qualification that this increased likelihood is largely driven by substance abuse (see Seena Fazel’s 2009 meta-analysis, which cumulatively examines findings from 20 similar studies) and an array of other risk factors that are more common among individuals who have severe mental illnesses (Elbogen and Johnson’s 2009 study). These factors range from the presence of certain psychotic symptoms (for example, an individual’s perception of threats against them), a person’s sex, and other stressors, such as victimization and unemployment, to name a few. Furthermore, when citing empirical research as rationale for policy, one must also consider the limitations of the research, the study subjects, and even the definition of “violence.” Although more similarly nuanced explanations have made it into some discussions since the shooting (Seena Fazel’s piece in the Wall Street Journal, for instance), they are largely absent from the public debate.

Clearly, the relationship between mental illness and violence is complex. While there is utility in seizing high-profile events as catalysts for much-needed reform, advocacy in the wake of tragedy must proceed with caution and ward against simple policy solutions for complex problems.
 

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