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What is the connection between mental illnesses and violence?

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Not enough articles examine mental illness and gun violence in the United States. What is the connection between mental illnesses and gun violence? In recent months, the United States has experienced a rise in gun violence. The current surge in violence is highly concerning and the reason highly contested. Regardless, the connection between gun violence and mental illness is misunderstood.

Even more troubling is the stigma around patients exhibiting homicidal ideation (HI) and suicidal ideation (SI) in the public mental health system. No one can say SI is without its privileged status in the HI/SI binary. Homicidal ideation is more of a public safety issue and is, therefore, the object of clinicians weaponizing safety concerns. Call centers, warmlines, and hotlines are all geared to target SI. When someone is suicidal, it is considered a mental health issue that needs urgent and careful clinical attention. However, people presenting as homicidal or dangerous to others are considered a substantial public safety issue requiring police intervention.

Are the sick or mentally ill more likely to kill people? Not at all. However, suppose mentally unwell people are not given the right outlets and resources like hotlines and walk-ins without a clinician calling 911. In that case, people with mental health disorders will continue to hurt unnecessarily. There needs to be a helpful and stigma-free treatment for people suffering from homicidal ideation.

Consider the loose nature of established and commonly agreed-upon definitions, especially within the mental health discourse. The terms “disorder,” “illness,” and “diagnosis” are sometimes used interchangeably despite having different meanings and applications. Even the word “mental health,” the most generic and monolithic of all terms in the discipline, is commonly confused and rarely talked about in a way where everyone is on the same page. Therefore, let us move past a post-modern take on the issue.

First, let us probe into recent gun violence in the US. Mentally ill people can be violent and use weapons as a direct or indirect result of a heightened or mistreated condition. Untreated symptoms can make people or anyone (mentally ill or just resource-deprived) more dangerous, unpredictable, and desperate. The violence can manifest inward. 

Mentally ill people can be destructive or exhibit harmful behaviors toward themselves because their condition and symptoms are misdiagnosed or mismanaged concerning their mental health treatment. Mentally healthy people can also be dangerous and hurt people, such as on a political level concerning the military-industrial complex. Wars, mutually agreed upon violence, and permissible killing present a massive hiccup in the debate.

People aren’t mentally ill when committing violent crimes like murder or assault. However, these people continue to make up many people committing violent crimes. Let’s face it. People will kill anywhere and in any condition, for almost any reason, whether they are sick or healthy.

Sadly, the more we crosswalk and compare, the more it seems that people are built to kill, hurt, and harm others with guns or other violent means. Why am I suggesting this? Because only truly engrained harmful actions can carry out human instincts and behaviors proficiently at any level of human cognition, health status, sex, gender, age, religion, and the intersection of humanity.

Humans kill people for a variety of reasons. Humanity can and is dangerous at times, either because a person is sick mentally or someone hell-bent is claiming life and harming others. The issue is how to assess which reason, why, and to what degree is lethality or suicidality? For tragedies such as the school shooting in Texas or any other school shooting, clinicians need to read the red flags a little closer or at least not miss them altogether.

Let’s explore a few caveats. Using myself as a case example, I have done many unfathomable things while struggling with mental health issues. I still cannot express regret for many of the behaviors I feel were wrong. Since my diagnosis, I have also done fantastic, beautiful acts in my lifetime and would never want to forget these memories. 

The light outshines the darkness every time my freedom is involved. People with mental health issues can never give up the right to fail. Some societies grant people with mental illness this privilege. Other cultures, states, and countries place limits on weapons and the movement and freedom of people with mental health conditions. Suppose we continue allowing guns to circulate in the market. In that case, there will need to be more guidance from the current regulations and laws that guide psychotherapy and treating people with mental health disorders in the US.

In New York, as in many other states in the US, unless you are mandated or in a forced treatment program, you can fail out of society and be admitted to a psychiatric hospital for rehabilitation. Commonly called assisted outpatient treatment (AOT), people labeled violently and persistently mentally ill cycle back into the system. The pattern should go from being a patient in the hospital to independent living. However, sometimes lives and mental conditions take their turn.

Some states operate differently and offer people fewer freedoms. Some states provide more privileges but less supportive services. The endorsement of the right to fail must be a national human right for public mental health care recipients. Mental health regulatory bodies profess dignity, hope, and recovery for the modern mission of the New York Office of Mental Health and other states.

The sickest irony (no pun intended) is when people pay attention to the history of our mental health system. The all-important pendulum or risk continuum is called “dignity in risk” or “risk of harm.” By basic definition, the dignity of risk is the right to take chances when engaging in life exploration experiences and the right to fail in these activities or life without harming oneself or someone else.

For many Americans, the risk of harm is an impending threat. People with mental illnesses are not trusted. Their judgment and insight may be impaired, and the public risks substantial physical injuries to themselves or others. Healthy people aren’t always trustworthy and could put the public in harm’s way just as much as their mentally ill counterparts. And so, the debate still rages on in 2022.

The truth is, publicly, since deinstitutionalization, society isn’t sure about the future of people living with diagnosed mental health conditions in the community. Unfortunately, the current mental health treatment plans don’t know the answers to essential questions and continue to be off the mark when predicting outcomes. Clinicians will need to do more to assess and predict public safety outcomes.

Do professionals ever really know what other people can do? Clinicians assess for safety concerns and look at the complete clinical picture of a person before releasing their patients into the community. I think clinicians must begin to be more tuned into the degree of harm and predict the threat level. For example, clinicians may think someone is at risk of suicide but fail to indicate a more significant, severe threat to themselves or the public.

Then, clinicians will need to be more trained in de-escalation and crisis intervention. Without knowing how bad it can get, it is challenging to get a read on what could happen if there is a sudden loss or drop in impulse control and what that might mean for someone who is actively homicidal or suicidal. 

Indeed, lethality is scaled. Concerning HI, SI, and the potential risk of harm, clinicians sometimes forget that these considerations are less static and exist as an abstraction and continuum.

So, are all things considered? And is this enough? Everyone makes their own decisions moving forward.

About the Author

J. Peters

Max Guttman is the owner of Recovery Now, a private mental health practice in New York City. Through his work as a Licensed Clinical Social Worker, therapist, and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a ‘2020 Bearcats of the Last Decade 10 Under 10’ award from the Binghamton University Alumni Association.

Guttman treats clients with anxiety and depression but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes about his lived experiences with schizophrenia.

‘I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery,’ Guttman says. ‘After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my ‘break,’ I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others.’

‘In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity, and candidness to my practice. People genuinely appreciate candidness when it comes to their health and Recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing a more egalitarian therapeutic experience for my clients.’

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