Report: Majority of mass violence not linked to mental health
A new report from the Medical Director Institute (MDI) of the National Council for Mental Wellbeing examines the connection between the rise in mass violence and mental health.
The findings from the report—“Mass Violence in the United States: Definition, Prevalence, Causes, Impacts, and Solutions”—show that while mental illness can play a role in some cases of mass violence, the media and members of the public often too quickly blame mental illness for all mass violence.
“We have the ability to take effective steps right now to curtail mass violence, but we have not adequately addressed the crisis,” said Joe Parks, MD, co-chair of the MDI and medical director of the National Council for Mental Wellbeing. “There are a very small portion of mental illnesses that do result in an increased potential for violence. In the vast majority of mass attacks, it’s not mental health to blame, but hate and anger. Hate and anger are not mental illnesses.”
Research has shown that people with serious mental illness such as schizophrenia and bipolar disorder are responsible for only about four percent of all violence, wrote Chuck Ingoglia, CEO of the National Council for Mental Wellbeing in a LinkedIn post about the research.
“The best predictor of future violence is past violence,” he said.
Robert Kinscherff, Ph.D., JD, executive director, Center for Law, Brain & Behavior at Massachusetts General Hospital said the report mirrors what he has observed in his own practice.
Kinscherff, also a professor in the doctoral clinical psychology program at William James College, was part of the expert panel that worked on the first version of the report in 2019, “Mass Violence in America.”
The findings indicate that behavioral health professionals must be cautious and well-informed when attributing acts of violence to mental illness rather than criminogenic attitudes, values, and beliefs that justify and maintain violence, he said.
They often require use of evidence-based interventions to address and change them and not merely treatment to diminish symptoms.
“Behavioral health treatment of persons with histories of violence must consider whether a psychiatric disorder is a sole or primary driver of violence – and in most cases, that will not be the case,” said Kinscherff. “In fact, effective treatment of mental illness without focused attention to criminogenic attitudes, values, and beliefs may yield a person who is no longer manifesting symptoms of mental illness but who remains disposed to instrumental (goal-oriented) or reactive violence – and potentially more, rather than less, a threat.”
The report calls for expanding the use of and funding for threat assessment teams that can identify potential attackers and address situations before they approach crisis levels.
“It’s crucial that we arrive at a uniform definition of mass violence and support research on the nature of attackers and what contributed to their actions, including neurobiological, psychological and sociological factors,” said Ingoglia.
Because standard clinical training often does not provide practitioners with sufficient skills to assess and/or intervene with persons who have histories of violence, behavioral health practitioners often need to acquire additional training for effectively working with people with significant histories of violence, Kinscherff said.
“From a policy perspective, reducing violence and mass violence to a ‘mental health problem’ risks further unwarranted stigma for persons with mental disorders, distracts from the actual individual, contextual, and systemic root causes of violence, and diverts attention and resources from addressing those root causes,” he said.
To create the report, the MDI convened a diverse panel of individuals with expertise pertaining to mental health care and violence for a two-day meeting. This included clinicians who treat people living with mental illnesses, as well as administrators, policymakers, researchers, educators, advocates, law enforcement personnel, judges, parents, and payers.
Panel members provided input from their own experience and research, including their personal perspectives on mass violence.
The report defined mass violence as a public health emergency, and stressed the need to identify root causes of mass violence quickly to alleviate them, rather than focusing on quick fixes.
One important component, the report said, was ensuring quality mental health care for everyone. This would include establishing an adequate mental health workforce, geographic distribution of facilities and access, and reducing stigma and other barriers to seeking care.