In the United States, access to adequate mental health services is a struggle for many. For example, data from 2019 show that over 13 million adults within the United States navigate “serious mental illness,” or SMI. Serious mental illness typically includes diagnoses like schizophrenia or bipolar disorder that can severely limit daily functioning. One in three of people with SMI received no mental health treatment in the year prior to reporting. As for violence, research shows that of the small percentage of people dealing with psychiatric disabilities who are arrested, a majority of offenses are minor and nonviolent, including trespassing and public intoxication.
The Danger of Biases
When someone with a mental health disorder engages in violent behavior, there is a tendency to extrapolate that to other people with the same or similar disorders, ignoring the millions of people with a mental health condition who have never been violent. Sabrina Sarro, LMSW, says, “I’ve had a mixture of colleagues, clients, and folks in my life assume that certain diagnoses automatically imply or mean violence. This is inherently problematic and harmful as it perpetuates stigma and the overall conclusion that if someone exhibits certain symptoms of a specific diagnosis, that they are then predisposed or bound to commit or participate in violence." Sarro names bipolar disorder as one example: “Many clinicians do not want to work with patients who might fit the criteria…and call these folks ‘difficult,’ ‘manipulative,’ and ‘dangerous.’ " They say this can isolate and dehumanize people who need help with a complex disorder and further separate them in society.
Racial Disparities in Identifying Mental Health Issues
The Harvard Psychiatry Review series references the headlines within the media that often arise after mass shootings, questioning if the assailant was mentally ill. Sarro notes that it has been common in these situations for media to explain a shooter’s motives in terms of mental health conditions—specifically when the shooter is White. Sarro says it has seemed much easier for people to explain violence by White perpetrators in terms of mental health, whereas a Black person may be called violent even if they haven’t committed a crime. “We cannot talk about violence and mental health without talking about race, white supremacy, and gender,” they say.
Not All Mental Health Issues Are Alike
Addressing these differences around who perpetrates violence, how it is perpetrated, as well as how we respond to said violence all plays a role in how we handle mental health conditions. In addition to biases around who is suffering, there are also assumptions that all psychological disorders are alike, showing up in the same ways and posing the same threats. Nekeshia Hammond, PsyD, says, “Some assumptions I have encountered surrounding mental health and violence are people will be violent if they are experiencing mental health distress. Another issue is the mentality that mental health conditions are ‘all the same’ or ’everyone will be violent.’” Hammond notes that there are over 200 forms of mental health disorders, so diagnoses should not be broadly lumped together. “One in five US adults experience mental illness, so to overgeneralize that violence is linked to individuals who have a mental health [issue] is a disservice to individuals experiencing mental health concerns.”
Commonality of Violent Behavior
Hammond says the vast majority of people with mental health problems are no more likely to be violent than anyone else. Individuals with serious mental illness are 10 times more likely to be survivors of violence as opposed to perpetrators. Sarro says, “Linking violent behavior and mental illness can [itself] be violent and can impose incorrect and narrow-minded assumptions on folks with mental illness or who experience divergent mental experiences. Linking these two as an automatic fact takes away from the very real reality that not all folks who experience mental illness are violent or engage in violent behavior.” Although the exact numbers vary by study, data suggest that only 3%-5% of violent crimes are connected to serious mental illness. Furthermore, when people with mental health issues do perpetrate crimes, often there are mediating factors such as poverty or substance abuse. For anyone looking to explain high crime rates in the U.S., mental health issues are no more to blame than any other factor. “Sure, there are connections between mental illness and the potentiality for violence. A person experiencing psychosis might react violently if they are experiencing a break from reality and attempt to defend themselves,” Sarro says. “A person who is experiencing a manic episode might have a delusion that causes them to react violently. This can happen and does, but we also need to critically analyze and assess who typically enacts violence on people and why.” Rather than supporting the idea that those with psychiatric disabilities are inherently violent, these data underpin the idea that proper assistance and intervention are key to our overall societal health.
Understanding Why Violence Happens
When someone commits a violent crime, it is easy to dismiss that person’s experiences and the things that may have led them down a path toward violence. Without justifying or condoning said violence, being intentional about getting to the root cause can be an avenue for adequate intervention. “What does it mean when Black/BIPOC communities need/want to engage in ‘violence’ to protect themselves?” Sarro says. It is imperative that everyone has not only an understanding of the complexities of violence and psychological health, but an appreciation for how anyone could be subject to a violent moment. “There needs to be more training for different sectors who encounter the public, such as in law enforcement, education, health care, and the like. Professionals need to have an overall better understanding of the dynamics of mental health and how to de-escalate situations,” Hammond says. “When professionals have this training, we can reduce the number of incarcerations, deaths, hospitalizations, and overall negative and unnecessarily violent encounters.” There is a very tangible stigma around mental health issues in general, and this can be exacerbated in cases where violence is involved. It is vital, especially for those who work directly with members of the community, to push against that manufactured bias. Data support the fact that while many individuals within the United States are without adequate health care and mental health treatment, these issues are not responsible for a significant portion of violent crime rates.
