Are People with Mental Health Problems at Increased Risk of Violence - Essay Example

Are people with mental health problems at increased risk of violence? Name: University: Tutor: Date: Mental health is regarded as an integral and essential component of health. As this stands, various definitions have been brought forward to explain the meaning of mental health problems. According to American Psychiatric Association (1994), mental health problem is characterised by significant dysfunction in the individual emotions, cognitions and behaviours that depicts a disturbance in the biological and psychological processes underlying mental functioning. On the other hand, a mental health problem is the disturbance of or impairment in the functioning of the brain that result from any disorder or disability of the brain. From the definitions above, not all mentally related problems can be characterised as a mental problem. For instance, American Psychiatric Association adds that behaviours such as sexual deviancy, immoral conduct or dependence on drugs do not meet the threshold to qualify as mental health problem. To further affirm that definitions above only cover a subset of mental health problems, Corrigan et al. (2002) argue that making the definition specific to other behaviours that may be related to it, mentally ill person should be said to have neurological and other causes of brain dysfunction such as multiple sclerosis, chronic intellectual impairment and autistic spectrum individuals. Therefore mental health problem is not encompassing term. Rather, a subset of behaviours related to depression, bipolar and schizophrenia among other things. Unless otherwise stated, violence on the other hand can be explained as inducing physical and or psychological harm to others. Since inducing violence to people can be regarded as a factor to determine social stigma and discrimination, there is a need to critically asses the link between mental health problem and violence. Psychiatrists, especially those attached to the emergency care settings have at least reported that they experienced violence with people having mental health problems. Albeit such can be documented, there has been general consensus among psychiatrists that violence is not representative of the behaviours of majority of people with mental health problems. In fact, even in the treatment units characterised with clinical mix and acuity, rates of violence have been reported to differ significantly, signaling that people with mental health problems may not be necessarily violent. Instead, while examining the antecedents of violent instances in inpatient treatment units, cases of violence endured by psychiatrists and other medical practitioners were as a result of factors such as ward atmosphere and ‘clinical leadership.’ Corrigan et al. (2002 pp. 481-82) In other countries, United States included, there has been sophisticated public opinion regarding the link between mental health problems and violence. A practical example relates to a research conducted by Pescosolido et al. (1999). This group carried a survey on American public (N=1,444) by the aid of the standardised vignettes to find the relationship between mental health problems and violence. Respondents rated the following groups as more likely or somewhat likely to cause violence to other members of public. Drug addicts (86.4%) more likely Alcoholics (72.2%) more likely Schizophrenic (23.4%) somewhat Major depression cases (18.3%) somewhat Troubled (10.2%) somewhat Before analysing the above statistics, it is important to note that drug addicts and alcoholics reported by the research to be more violent or more likely do not qualify a person as a mental ill as far as definitions above are concerned. Figures above have ranked drug addicts and alcoholics as the highest risk groups while rating schizophrenic and depressed individuals as those who are unlikely to be violent. The research also noted that drug addicts and alcoholics in relationships recorded higher number of violence with their partners complaining to have been coerced, hit, punched or threatened with a gun or knife. On the other hand, response from those who had mentally ill partners claimed that their partners were more reserved and were not as violent as the groups mentioned above. In this regard, Pescosolido et al. (1999) argue that people with mental health problem are always poor and live in impoverished neighborhood where they are often bullied, victimised and violated. Using the same approach, Australian study tried to assess what proportion of violent related crimes involving a police arrest and prosecution could be linked with individuals with mental ill health. The survey which was conducted among the newly 1,151detained criminal offenders showed that people with major mental health problems such as depression, schizophrenia and bipolar recorded the lowest cases of violence. The research found out that most of mentally ill offenders who were accused of violence were substance abusers as well. A more accurate assessment of the violence related to mentally ill individuals is that of epidemiologic studies of community samples. Such is the NIMH's Epidemiologic Catchment Area (ECA) study. This study examined the link between psychiatric disorders and the rate of violence. In this study violent person is seen as one who has used an object or weapon in a fight and having been part of the fight. The outcome of the study revealed that patients with mental problems---those with major depression, bipolar and schizophrenia less likely as people without mental problem to be violent. In absolute terms, prevalence of those with mental health problems was 12% compared to 23% among those without mental health problem. Even as the percentage stands at 12 not all types of psychiatric illness are link to violence---anxiety disorders among the psychiatric cases for instance seemed to increase the link. Furthermore, the research concedes that individuals with purely serious mental illness were quite rare and thus such statistics also included people with mental health problem who were also abusing drugs. This translates that the violence related cases from purely mental ill health individual can even be lower than the recorded percentage. One damaging misconception that people should deal with regarding mental health problem is the belief that such individuals are unpredictable and dangerous. For instance, Survey conducted by American Psychiatric Association reports that 38% of the respondents argue that such group can harm people especially when we are least expecting such. The worst still is that those interviewed believed that everyone with mental health problem is a ‘mad axeman’. However, documented facts do not support or justify such allegations. To begin with, a Reassessment of the Link between Mental Disorder and Violent Behaviour, and its Implications for Clinical Practice carried out by Muller (1997) in New South Wales suggests that violence related cases from people with mental health problems accounts for smaller percentage as compared to their counterparts. This finding concurs with that of Modestin (1998) when he was investigating crime and violent behaviour in schizophrenic patients. Interestingly, The National Confidential Inquiry into Homicide and Suicide by People with Mental Illness, reports that only 8% of homicides, about 59 of the 600 homicides reported in Australia are committed by someone with a person having mental health problem. Our point of reference can also be the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) which has been a 2-wave face to face surveying the link between people with mental health and violence. Guided by the designed epidemiological studies on mental ill health individuals, subjects in the study were given codes as; 1= no major illness, substance abuse or dependence. 2= schizophrenia individuals 3= people with bipolar disorders 4= people with major depression After reviewing the responses, it was agreed that people coded 2, 3 and 4, whether in the, hospital, prison or community exhibited lower levels of violence than the general populations. The data in the table below can be used to show the link between people with mental health problem and rate of violence. A review of this data also shows that people with mental illness are not necessarily violent. Courtesy of Epidemiologic Catchment Area (ECA) study Sometimes babies are born with mental illness and it has been important to ascertain if they to depict any level of violence. Birth cohort studies from Scandinavian longitudinal prospective reveals that after 30 years of research, there is no increased risk of violence among babies who are mentally ill. Methodologically, similar Finnish and Danish studies replicated such results. Babies diagnosed of schizophrenia did not show any signs of increased violence when compared to their counterparts (Rasanen et al, 1998). Neither the work of the work of Arseneault et al (2000) nor the state-of-the-art epidemiological study shows any link between mental ill babies and rate of violence. In addition to these, research findings claiming any relationship between people with mental health problem and violence need to be certain about the chronological ordering of events. Otherwise we can be left to wonder whether mental illness precedes violence or the other way round is true. Conclusion Since researches have failed to provide any link between people with mental health problem and violence the findings highlighted in this research strongly challenge perceptions that mentally ill people cause violence in the general public. Still to be considered in this research is that not even a single data presented to give a counter argument has managed to show by what percentage or rate among the mentally ill are violent. Instead, it has generalised by assuming that every person mentally ill is violent. Consequently, to understand the link existing between people with mental problem and violence, other parameters such as substance abuse, history of the violence and the environmental stressors. References Arseneault, L., Moffitt, T., and Caspi. (2002). Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry 57:979-86. American Psychiatric Association, (1994) Fact Sheet: Violence and Mental Illness. Washington, DC: American Psychiatric Association. Corrigan, P.W., Rowan, D., and Green, A., (2002) .Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28, 293-309. Mental Health America (1999). American Opinions on Mental Health Issues. Alexandria: NMHA. Modestin, J. (1998). Criminal and Violent Behaviour in Schizophrenic Patients: An Overview. Psychiatry and Clinical Neuroscience, (547-554). Pescosolido, B.A., Monahan, J. and Link, B.G. (1999). The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. Reassessment of the Link between Mental Disorder and Violent Behaviour (1997). Implications for Clinical Practice carried out by Muller. Tiihonen, J. Isohanni, M. and Räsänen, P. (1997). Specific major mental disorders and criminality: a 26-year prospective study of the 1966 Northern Finland Birth Cohort. Read More