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Mental Illness and Violence: A Link?
Mental Illness Alone Doesn't Predict Violence, but Substance Abuse Increases Risk for Mentally
Ill, Study Shows
Feb. 2, 2009 -- When horrific
acts of violence erupt, such as killing rampages on school campuses or mass slayings by heads of families, the public often
reacts by saying the offender must have been "crazy."
Although mental illness and violence
are often thought by society to go together, the perception is not entirely true, according to a new study.
alone does not increase the risk of violence," says Eric Elbogen, PhD, assistant professor of psychiatry at the University
of North Carolina at Chapel Hill School of Medicine, citing the results of his recent study published in the Archives of
But when mental illness is combined with other risk factors such as substance abuse, it does increase the risk of violence,
Elbogen found. Mental illness "makes a difference but only in the presence of other risk
factors," he says. Besides substance abuse, Elbogen looked at such other factors such as a history of violence, age, gender,
and stressors such as losing a job or getting a divorce.
Mental Illness &
Violence: The Study
Previous research has produced
mixed results about the link between mental illness and violence, with some finding a clear
association and other studies finding, as did Elbogen's, that alcohol and drug abuse increases the risk in the presence of
a mental illness.
For his study, Elbogen evaluated
data on nearly 35,000 people, all interviewed about their mental health, history of violence, and use of substances between
2001 and 2003. Participants were part of the National Epidemiological Survey on Alcohol and Related Conditions, conducted
by the National Institute on Alcohol Abuse and Alcoholism.
At the first interview:
- Nearly 11% of participants said they had been diagnosed with
mental illness, including schizophrenia, bipolar disorder, or major depression.
- 21.4% had substance abuse or substance dependence.
- 9.4% reported a severe mental disorder and substance
abuse or dependence.
The percentage of participants
reporting a mental illness reflects the percentages found in the general population and
in other studies, Elbogen says.
In a second interview conducted
in 2004 or 2005, participants were asked about any violent behavior, such as committing a sexual assault, fighting, or setting
fires, in the time between interviews.
Mental Illness &
In all, 2.9% of participants
said they had been violent in the time between the first and second interviews.
When Elbogen evaluated the
possible associations between mental illness, violence, and other factors, having a mental illness alone did not predict violence, but having a mental
illness and a substance abuse problem did increase the risk of violence.
The risk was increased even
more if the person had mental illness, substance abuse problems, and a history of violence.
For instance, when Elbogen
looked at those who only had a severe mental illness, 2.4% had been violent. But when he
looked at those with major depression and substance abuse or dependence, 6.47% had been violent.
You can read my own personal thoughts concerning mental illness and violence
- substance abuse and alcoholism and violence and mental illness from my own experiences by clicking here.
When he looked at those with
schizophrenia, 5.15% reported violent behavior in the time period between the interviews. But when a person with schizophrenia
also had substance abuse or dependence problems, 12.66% reported violent behavior in the time between the interviews.
The highest risk for violence was found in those who had mental illness, a substance abuse problem, and a history of violence. These participants had 10 times the risk
of violence than those who only had mental illness.
Other factors that predicted
violent behavior included a history of juvenile detention or physical abuse, having seen parental fighting, a recent divorce,
unemployment, or being victimized themselves. Being younger, male, and low-income also boosted the chance of violence.
"There is a relationship [between mental illness and violence] but it's much
weaker than most people think," he tells WebMD.
"I think a lot of people think mental illness is the usual cause if not the foremost cause of violence," Elbogen says, citing
a survey in which 75% of respondents said they considered people with mental illness as
But his study concludes that
“the findings say mental illness is relevant and you can see that throughout the data.
But it's not really one of the foremost causes of violent behavior [by itself]
in our society."
Mental Illness & Violence: Second
Experts who reviewed the paper
for WebMD say they hope the new research may change mistaken perceptions toward those who are mentally ill.
"Having a severe mental illness alone doesn't predict anything," as far as violence, says Philip Muskin, MD, professor of clinical
psychiatry at Columbia University in New York. The new results, he says, confirm some other studies with similar results.
For those affected by the
severe mental illnesses evaluated in the study, Muskin says, "You are no more at risk for
committing a violent act than anyone in the population."
Paul Appelbaum, MD, former
president of the American Psychiatric Association and a professor of psychiatry at Columbia University, says, "If you take
the body of data as a whole, I think what everyone would agree with is, if there is an impact of mental
illness on violent behavior it is not very great. And there is no question that the overall contribution of people
with serious mental illness to violence in our society as a whole is quite small."
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De-Criminalizing Mental Illness
By M.J. Stephey Wednesday, Aug. 08, 2007
"Psycho." "Freak." "Jason
from the horror movie." These are the answers that counselor Habsi Kaba gets from Miami police officers when asked to describe people with mental illness.
Such stereotypes are surprisingly common, says Kaba, and not just within law enforcement. But these misconceptions are especially
dangerous when they're held by police, who are often forced to make split-second, life-or-death decisions about mentally ill suspects. "The worst thing you can have is power and lack of knowledge," Kaba says.
Just ask Mike, 31, who knows
firsthand. Mike suffers from schizophrenia, bipolar disorder and depression. Since the age of 17, the Los Angeles native has been repeatedly arrested during psychosis for nuisance crimes like disturbing
the peace, only to serve his time, fall off his medication and get arrested again. On three separate occasions, his hallucinations were so severe he tried to commit suicide by provoking
the police to shoot him. Though he is receiving treatment, rising health care costs and declining federal help mean Mike will
likely end up in jail again.
L.A. Police Lieutenant Richard
Wall told Mike's story to members of the House Judiciary Committee in March, in support of the 2007 Second Chance Act, which
aims to reduce recidivism, in part with better mental health treatment for prisoners returning
to society. Prisons, Wall testified, have become the nation's "de facto" mental health care provider. According to the Federal
Bureau of Justice Statistics, there are currently 1.25 million inmates like Mike, with debilitating disorders ranging from
schizophrenia to post-traumatic stress disorder, abandoned in the U.S. prison system instead of receiving treatment in hospitals.
"If you think health care
in America is bad, you should look at mental health care," says Steve Leifman, who works as a special advisor on criminal
justice and mental health for the Florida Supreme Court. More Americans receive mental health treatment in prisons and jails
than hospitals or treatment centers. In fact, the country's largest psychiatric facility isn't even a hospital, it's a prison
- New York City's Rikers Island, which holds an estimated 3,000 mentally ill inmates at
any given time.
Fifty years ago, the U.S.
had nearly 600,000 state hospital beds for people suffering from mental illness. Today,
because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run
hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without
proper treatment and care, many ended up in the last place anyone wants to be.
"The one institution that
can never say no to anybody is jail," Leifman says. "And what's worse, now we've given [the
mentally ill] a criminal record."
Most police officers aren't
trained to deal with people suffering from severe mental illness. But because they are the
first to respond to calls involving psychiatric crises, police are in a unique position to fix the crippled system. That effort
is now under way, thanks to Crisis Intervention Teams (CIT), which are being adopted by a growing number of police departments
across the country.
The concept was pioneered
by the Memphis Police Department in 1988 after an officer shot and killed a person suffering from schizophrenic hallucinations.
Working with the National Alliance for the Mentally Ill and two local universities, Memphis police trained and organized a
unit of officers specifically to deal with people in psychosis - a mental state commonly suffered by patients with severe mental illness in which their thoughts don't match up with reality.
In these cases, normal police
procedures often increase the chances of violence, confusion and even death. So, police officers are taught to approach psychotic
suspects in a different way: by speaking softly, rather than shouting commands, repeating phrases, holding hands palms-up
instead of holding a gun or badge, and wearing plainclothes instead of uniforms. These actions may seem minor, says Kaba,
who is the CIT training coordinator for the Miami Police Department, but they go a long way in breaking down the barriers
- psychological and otherwise - that often exist between the mentally ill and police.
The ultimate purpose of the
CIT program is perhaps empathy. Using a device called Virtual Hallucinations, officers can begin to understand what it's like
to be in the grip of a severe and untreated mental illness. Made by the pharmaceutical company Janssen, the rig and headphones
simulate the disturbing and disorienting environment of a psychotic episode.
After using the rig, Lt. Wall
of the LAPD says he was struck by the idea of being exposed to such chaos all the time. "It's just a scary thing," Wall says,
"I can do it and walk away from it." Those with serious mental illness, however, cannot.
Community members like John
Kowal, 54, work with CITs to provide officers with a more intimate knowledge and understanding of psychosis. Kowal, who suffers
from bipolar disorder and alcoholism, has been working with Miami's Police Department and inmates as a "peer specialist." His duties range from
consultant to mediator to companion. "I can bond with [mentally ill inmates].
I can say, 'Hey, I was in jail. I take medicine. It's worth it,'" Kowal says. "I don't go by a book. I'm like a friend."
Likewise, the program challenges
stereotypes of law enforcement officers as trigger-happy bullies. "Just like police don't understand people with mental illness, we don't understand them," Kaba says. "They're social workers, they're brothers and sisters,
they're priests. They play every role out there."
Some officers initially dismissed
the CIT program as run-of-the-mill sensitivity training or extreme political correctness, but Cindy Schwartz, director of
Florida's Eleventh Judicial Circuit Criminal Mental Health Project, says those same officers now marvel at the program's success.
The CIT model has received numerous awards from nationally recognized mental health organizations, law enforcement agencies,
and humanitarian groups for treating mental illness as a disease, not a crime. Such change cannot come too soon.
Last December, the Advocacy
Center for Persons with Disabilities filed a federal lawsuit against the state of Florida, alleging that it was violating
the civil rights of hundreds of mentally ill convicts and inmates awaiting trial by leaving
them jailed and without treatment. "We reached a crisis point," says Leifman, the Florida judge, of the state's inability
to address mental illness. "We have hundreds of defendants languishing in jail." It got
so bad that two mentally ill inmates in a Pensacola, Fla., jail died after being brutally
subdued by guards. And in Clearwater, Fla., a schizophrenic inmate gouged out his eye after waiting weeks for a hospital bed.
In June, New York legislators
passed a bill outlawing solitary confinement for mentally ill inmates after a study found
that such isolation - to which mentally ill prisoners are often subjected - worsened psychiatric
symptoms and often led to self-mutilation or suicide attempts.
When it comes to mental health
care in the U.S., Leifman says, history is repeating itself. During the 1800s, long before state-run agencies existed to treat
mental illness, families would simply drop their loved ones off at jails or prisons, where
their conditions remained untreated. Then came state-run hospitals that Leifman refers to as "horror houses" given that patients
were usually either neglected or abused — experiments involving drugs and electroshock therapy inspired movies like
One Flew Over the Cuckoo's Nest and finally drew the public's attention to the civil rights abuses of people with mental
illness. There appeared a glimmer of hope in 1963, when President Kennedy, in what would be his last public bill-signing,
authorized $3 billion to create the first national network of mental health facilities. But after Kennedy's assassination,
the country turned its focus to Vietnam and not one penny went into the project.
"It's the one area in civil
rights that we've gone backwards on," says Leifman, noting that nearly half of the nine floors in Miami-Dade's County Jail
are mental health wards, even though the building is "more like a warehouse than a facility." He decries the conditions that
these inmates face, including vermin-infested, decrepit buildings that lack adequate ventilation, lighting and water supplies.
Leifman also laments the amount of taxpayer dollars used to fund such an inadequate system. Taxpayers in Miami-Dade County
spend $100,000 each day to house the mentally ill in prison; moreover, studies show that
people with mental illness stay in jail eight times longer than other inmates, at seven
times the cost.
"We can't really build our
way out of the problem. It's not just about state hospital beds or jails," Leifman says. "We need to really take a hard look
at how we're dealing with the problem overall."
The original version of the story incorrectly stated that CIT was created by the Memphis Police Department
after one of its police officers was shot and killed by a person suffering from schizophrenic hallucinations. In fact, the
schizophrenic man was shot and killed by police.
source site: click here to open a window that reveals Time Magazine Online!
29% of depressed Americans who haven't seen a therapist in the last year
Shape, Dec, 2008
If you're suffering from a
case of the winter blues but don't know where to turn for help, get a list of psychologists in your area at locator.apa.org.
SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION
COPYRIGHT 2008 Weider Publications
COPYRIGHT 2008 Gale, Cengage Learnin
National study finds post-traumatic stress disorder common among
Published: Wednesday, September 10, 2008 - 23:22 in Health & Medicine
Suffering a traumatic injury
can have serious and long-lasting implications for a patient's mental health, according to the largest-ever U.S. study evaluating
the impact of traumatic injury. Researchers from the Harborview Injury Prevention and Research Center, the University of Washington, and the John Hopkins
Bloomberg School of Public Health found that post-traumatic stress disorder and depression were very common among patients assessed one year after suffering a serious injury.
They also found that injured
patients diagnosed with PTSD or depression were 6 times more likely to not have returned to work in the year following the injury.
The study followed 2707 injured patients from 69 hospitals across the country, and found 20.7% had post-traumatic stress disorder and 6.6% had depression one year after the injury.
Both disorders were independently
associated with significant impairments across all functional outcomes: activities of daily living, health status, and the
return to usual activities, including work. Patients who had one disorder were 3 times less likely
to be working one year after injury, and patients with both disorders were 5 to 6 times less likely
to have returned to work.
The findings have important
implications for U.S. acute care hospitals. Smaller scale investigations in acute care medical settings suggest that evidence-based
psychotherapy and collaborative care interventions can reduce the symptoms of PTSD and related conditions among injured trauma survivors.
"This study highlights the
importance of ongoing studies of PTSD and depression screening, and intervention procedures for injured patients treated in acute care hospitals nationwide," said Douglas Zatzick,
M.D., principal investigator and a psychiatrist at the University of Washington.
"If studies of PTSD and depression establish the effectiveness of screening and intervention procedures, American College of Surgeons policy requirements similar
to the recent mandate for alcohol screening and brief intervention could be considered."
The American College of Surgeons
now requires that level I trauma centers must have on-site alcohol screening and brief intervention services as a requisite for trauma center accreditation.
Breast cancer patients who
have a prior history of mood and anxiety disorders are at a much higher risk of experiencing post traumatic stress disorder following their diagnosis, new research suggests. A study of 74 breast cancer patients at the Ohio State University Medical
Center found that 16 percent of them (12 women) suffered from PTSD 18 months after diagnosis.
Women with PTSD were more than twice as likely as breast cancer patients without the disorder to have suffered from previous mood disorders
such as depression before the cancer diagnosis. They were also more than three times more likely to have experienced anxiety disorders.
“What is unique about
breast cancer patients with PTSD is that they have already had this double hit of both anxiety and mood disorders even before they got the diagnosis,”
said Barbara Andersen, co-author of the study and professor of psychology at Ohio State University.
“So when they are in
a new situation that is very anxiety provoking – cancer diagnosis and treatment – it is not surprising that they
are at risk for developing PTSD.”
The findings suggest that
doctors should screen newly diagnosed breast cancer patients for past mood disorders, she said. Those who have histories of
mood and anxiety disorders may need help in order to avoid PTSD. However, the results also show that most breast cancer patients aren’t at risk for PTSD.
Andersen conducted the study
with Deanna Golden-Kreutz, clinical research manager at Ohio State’s Cardiovascular Clinical Research Unit, and Rebecca
Shelby, a former Ohio State graduate student now at the Duke University Medical Center.
Their study appears in the
April 2008 issue of the Journal of Traumatic Stress.
In addition to the women who
had PTSD, another 20 percent (15 women) had “subsyndromal” PTSD, meaning that they experienced significant symptoms of PTSD, but not at the level of those with the full diagnosis.
Patients with subsyndromal
PTSD were more likely than others to have had mood disorders, but compared to those who had full PTSD, were much less likely to suffer from anxiety disorders, Andersen said.
The findings showed that past
alcohol and substance abuse was also linked to post traumatic stress disorder symptoms. About one-third of women with PTSD had a past history of alcohol/substance abuse or dependence, compared to 1/5 of subsyndromal women and 1/10 of women with no PTSD.
Another issue for women who
had PTSD – as compared to those with subsyndromal PTSD and those with no PTSD -- was a history of traumatic life events, the study found. For example, 1/2 of the PTSD patients reported having been physically attacked or abused in their lives, compared to less than 17% of women in the other two groups.
Although women with subsyndromal
symptoms generally fared better than those with the full disorder, in some cases women in both groups faced significant coping difficulties. Women in the two groups were nearly 4 times more likely than those with no PTSD to say they were unable to work because of emotional distress (42% of PTSD group, 40% of subsyndromal group, and 11% of those with no PTSD.)
“That’s a huge
difference, and shows the real-life impact that PTSD symptoms can have on some breast cancer patients,” Andersen said.
While the study suggests most
cancer patients aren’t at risk for PTSD, Andersen said mood disorders are another matter.
“I think depression is the mental health condition that needs the most attention as far as treating breast cancer patients, even more so than
PTSD” she said. “That’s the direction our research is going, and we are working to develop an intervention to
treat cancer patients with depression.”
Gurion University of the Negev
(BGU) researchers found that a high dose of cortisone could help reduce the risk of post-traumatic stress disorder (PTSD). The article appears in Biological Psychiatry, Volume 64, Issue 8 (October 15, 2008), pages 708-717. In an animal
model of PTSD, high doses of a cortisol-related substance, corticosterone, prevented negative consequences of stress exposure, including
increased startle response and behavioral freezing when exposed to reminders of the stress.
Cortisol is secreted into
the blood stream through the adrenal glands, which are active when the body responds to stress. It is known as "the stress
hormone" because it is also secreted in higher levels during the body's "fight or flight" response to stress, and is responsible
for several stress-related changes in the body.
According to Dr. Hagit Cohen
of the Anxiety and Stress Research Unit at the Faculty of Health Sciences, Ben-Gurion University of the Negev, "A single intervention
with high-dose corticosterone immediately after exposure to a psychogenic stressor was highly effective in reducing the incidence
of PTSD-like behaviors and improved the resilience to subsequent trauma-cue exposure in an innovative controlled prospective animal
"Single high-dose corticosteroid
treatment may thus be worthy of clinical investigation as a possible avenue for early pharmaco-therapeutic intervention in
the acute phase, aimed at prevention of chronic stress-related disorders, such as PTSD," Cohen explains. "In this sense, it brings treatment of PTSD to a new era – an era of secondary prevention, an era of the golden hours."
it's in the news....
- a brief description of how people feel who have anxiety disorders
- what anxiety disorders are
- it's in the news.... current news articles from around the web concerning anxiety disorders
anxieties & depression...
- an explanation about how depression is usually found as well when an anxiety disorder is diagnosed
- it's in the news... depression & anxiety disorders
generalized & social anxiety
- description of both mental disorders classified as anxiety disorders
- feelings & emotions felt by those experiencing these disorders
- treatment basics for these disorders
- it's in the news for generalized & social anxiety disorders
- description of this mental disorders classified as an anxiety disorder
- feelings & emotions felt by those experiencing panic disorder with panic attacks
- treatment basics
- it's in the news for panic disorder & panic attacks
- description of the different types of phobias classified as anxiety disorders
- feelings & emotions felt by those experiencing phobias with or without panic attacks
- treatment basics
- it's in the news for phobias / agoraphobia
post traumatic stress disorder
- description of this mental disorder classified as an anxiety disorder
- feelings & emotions felt by those experiencing ptsd with or without flashbacks, nightmares,
dissociation, hyper arousal, hyper vigilance, derealization & panic attacks
- treatment basics
- it's in the news for post traumatic stress disorder
- military dealing with ptsd coming back from Iraq & previously in combat
- ptsd link to heart disease
- acute stress disorder
obsessive compulsive disorder
- description of this mental disorder classified as an anxiety disorder
- feelings & emotions felt by those experiencing ocd
- treatment basics
- it's in the news for obsessive compulsive disorder
- other compulsive & obsession disorders
- what are compulsions & disorders? rituals?
- description of this mental illness & how it is often comorbid with anxiety disorders &
- feelings & emotions felt by those experiencing depression
- treatment basics
- it's in the news for depression
how it all works