WV Behavioral Health Providers Association Statement on Mental Health and Gun Violence
Although it is common for there to be a discourse related to the causal impact of mental illness after media reports of gun violence, particularly those involving mass shootings, the relationship is not that clear. Questions often arise as to what can be done to better predict and prevent such atrocities. While public perception may suggest that a large percentage of mass shootings are carried out by individuals who are mentally ill, the link between mental illness and gun violence is complex (1).
In reality, there is little population-level evidence to support the assertion that individuals diagnosed with mental illness are any more likely to commit a gun crime than the general population. A number of the most common psychiatric diagnoses, including depressive, anxiety, and attention-deficit disorders, have no correlation with violence (2). Some studies have also shown that serious mental illness without substance abuse is also statistically unrelated to community violence (3). It is more likely that mass shootings represent anecdotal distortions rather than representations of the violent tendencies of those with mental illness. Consider the following statistics.
Less than 3-5% of U.S. crimes involve people diagnosed with mental illness.(4)
Of the 120,000 gun-related killings between 2001 and 2010, fewer than 5% were carried out by people diagnosed with a mental illness. (5)
Only about 4% of overall violence in the U.S. can be attributed to people diagnosed with mental illness. (6,7)
People diagnosed with mental illness are from 65 to 130% more likely to be victims of violence that the general public (8).
85% of shootings occur within social networks (9).
A 2013 NY City Police Department report indicated a person was more likely to die in a plane crash, drown in a bathtub, or perish in an earthquake than be murdered by a stranger with mental illness (10).
Given this information, we know that it is not helpful to draw broad generalizations related to people diagnosed with mental illness and gun violence. In particular, mass shootings represent statistical aberrations that reveal very little about population-level events. There are, however some specific risk factors that correlate with gun violence. Alcohol and drug use increase the risk of violent crime as much as 7-fold (11). A history of childhood abuse, binge drinking, and male gender are predictive
risk factors for serious violence (12). Given this information, we should focus more on assessing and intervening based on specific correlates with violent behavior rather than broad generalizations of “dangerousness” relative to those diagnosed with mental illness.
It should be noted that the specific risk factors may be different for different types of violence, settings, and populations (13). However, there are some primary predictors of violence that have been identified among people with mental illness (14). These include:
History of past violence
Drug and alcohol abuse
Failure to take prescribed medication
Other indicators of potential violence in those with a diagnosis of mental illness include:
Antisocial Personality Disorder
The primary concern in minimizing the likelihood that a violent act may be carried out by an individual diagnosed with mental illness is access to and engagement in adequate assessment and treatment services. It is estimated that 4 million Americans experience symptoms related to schizophrenia and bipolar disorder, and about 50% (~2 million) of these individuals are not receiving treatment (14).
A critical component of the assessment process includes a violence risk assessment and if warranted, an individualized safety plan. The violence risk assessment should include assessment of ideation, plan, intent, access to means, history of violent behavior, current level of substance use, level of social support, feelings of hopelessness, level of impulse control, and history of treatment compliance.
Rather than a generic “contract for safety”, mental health professionals should assist in the development of an individualized safety plan. This plan should indicate specific warning signs a crisis may be developing, individualized coping methods, list of available social supports, steps taken to limit access to means and make the environment safe, and emergency contact procedures.
Beyond the initial assessment phase the information presented also highlights the importance of engaging those with severe and persistent mental illness in treatment, not only for the psychiatric disorders, but also for substance use issues. Evidenced-based programs such as Assertive Community Treatment (ACT) and intensive case management have the ability to target many of the primary risk factors outlined.
Metzl J and MacLeish K. Mental Illness, Mass Shootings, and the Politics of American Firearms
Johns Hopkins Center for Gun Policy and Research. Guns, public health and mental illness: an evidence-based approach for state policy (2013)
Elbogen EB, Johnson SC. The intricate link between violence and mental disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2009; 66(2): 152-161.
Appelbaum PS. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006; 163(8): 1319-1321.
National Center for Health Statistics
Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006; 163(8): 1397-1403.
Friedman R. A misguided focus on mental illness in gun control debate. New York Times, Dec. 17, 2012.
Brekke JS, Prindle C, Bae SW, Long JD. Risks for individuals with schizophrenia who are living in the community. Psychiatr Serv. 2001; 52(10): 1368-1366.
Papachristos AV, Braga AA, Hureau, DM. Social networks and the risk of gunshot injury. J Urban Health. 1012; 89(6): 992-1003.
Hamilton B. Odds that you’ll be killed by a stranger in NYC on the decline. New York Post. January 5, 2014.
Monahan J, Steadman H, Silver E, et al. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York, NY: Oxford University Press; 2001.
Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012; 47(3): 487-503.
Pueyo AA, Illescas SR. Dangerousness and violence risk assessment. Papeles del Psicologo. 2007; 28(3): 157-173.
Predictor of violence among mentally ill: Lack of treatment or failure to accept treatment. Mentalillnesspolicy.org.
BEAVER, W.Va. – At an anti-drug community forum he organized in Beaver on Wednesday evening, U.S. Rep. Nick Rahall (D-W.Va.) announced that West Virginia has been chosen by the Centers for Disease Control and Prevention (CDC) to receive more than $1 million over the next three years for the development of an anti-drug abuse program that would serve as model for the rest of the Nation.
“CDC has given us an opportunity to lead. And lead we will. Already, in towns and cities and in the rural countryside we are combating the scourge. Our people are no stranger to adversity and challenge. Armed with adequate resources and the means to fight back, we will develop a model for other regions of our Nation. And we will ultimately prevail,” said Rahall.
This significant infusion of Federal funding will enable West Virginia to strengthen its prescription drug monitoring program and develop new drug-abuse prevention strategies, allowing the State to gear its Medicaid rules toward better protecting against drug abuse and overdose. West Virginia is one of only six states selected by the CDC to participate in this national initiative.
“This grant will allow us continue to battle against the serious consequences of prescription drug abuse in West Virginia,” DHHR Cabinet Secretary Karen L. Bowling said. “With the additional monies, DHHR will provide the needed support and services to families and communities affected by this growing problem.”
Rahall, who has been an advocate in Congress for increased Federal resources to strengthen drug monitoring and prevention strategies, hosted Federal Drug Control officials at the Erma Byrd Center of Higher Education for a community forum, which included Dr. Daniel Sosin, Acting Director, Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control.
“Drug abuse is an extremely difficult challenge, both for families and communities, and it requires patience and persistence in addressing. I intend to keep pushing hard in Congress to help our State get the Federal resources it needs to strengthen its law enforcement and public health strategies,” said Rahall.
Addendum: West Virginia Behavioral Healthcare Providers Association executive director, Mark Drennan addressed the panel from the perspective of addictions professionals. Drennan stated that adequately funding the full continuum of addictions services is imperative to treat those suffering from addictions. In addition, strong leadership at home and in communities is needed to curb the demand for addictive substances.
We lost an incredible icon yesterday. A man, a comic, a dramatic, Robin Williams brought us such joy and laughter, but in the end, found himself alone in the darkness of depression. If there’s any lesson to be learned in this tragic loss, it is that suicide is an equal opportunity killer. Depression, mental illness and addiction can happen to anyone, anywhere.
Since 1999, suicide among middle aged men has risen dramatically, according to the CDC — 27% to be specific. And, overall, suicide takes twice as many lives as homicide. Yet, it has the potential to be preventable. With better research, better identification, and better access to the right treatments and supports, we can prevent many of these unnatural deaths.
This is a sad time. Here at the National Council for Behavioral Health, our hearts go out to Robin Williams’ family and friends and to all of us who have lost the laughter he brought into our lives.
(Photo caption: Senator Jay Rockefeller accepts an award for his work on behalf of children from Mark Drennan of the West Virginia Behavioral Healthcare Providers Association, and Lisa Jones of ResCare, at the Alliance for Children’s annual meeting and senior leader’s conference at the Stonewall Resort in Roanoke, Virginia.)
Written by Your 5News Team
Last updated on May 29, 2014 @ 12:01PM
Created on May 29, 2014 @ 11:49AM
ROANOKE, WV – During a statewide conference on foster care and children’s well-being, Senator Jay Rockefeller was honored by the Children’s Home Society and the Alliance for Children for his dedication to improving services for children in foster care and promoting adoption.
Advocates, social workers, and families from across West Virginia joined in celebrating Rockefeller’s career.
“Every one of you—every parent, every advocate, every service provider and community leader in this room—is a committed and passionate champion for children. Your work is transforming lives and it inspires me each and every day. I am so proud of all we have accomplished to move West Virginia forward for our youngest ones,” Rockefeller said during the discussion.
As part of the Alliance for Children’s annual meeting and senior leader’s conference, Rockefeller presided over a panel discussion on children’s welfare, specifically foster care, adoption and permanency. Child welfare advocates joining Rockefeller included Scott Boileau, Executive Director of the Alliance for Children; Steve Tuck, CEO of the Children’s Home Society; Nikki Tennis, Director of the Division of Children’s Services, West Virginia Supreme Court; and Sue Hage, Deputy Commissioner for programs with West Virginia Division of Health and Human Services, Bureau for Children and Families.
“It’s amazing to be here and be able to share our experiences and to meet with the Senator,” Hage said. “We may not be where we need to be, but we’re working hard to create a safe environment for all children.”
Rockefeller has been a leader in those efforts, including work to promote adoption and improve services for at-risk children and foster children. He was a main architect of one of the most significant federal laws related to the welfare of the nation’s children, the Adoption and Safe Families Act, which doubled the number of adoptions after its enactment in 1997. The Senator has also introduced legislation to make interstate adoption easier; eliminate permanent foster care as a goal for children under 17; and provide funding for post-adoption and post-permanency services.
During the discussion, Rockefeller said that his time as a Volunteers in Service to America (VISTA) worker led him to a career dedicated to public service, with a specific focus on improving the health and well-being of children.
“I saw a lot of need in Emmons, a lot of children who were at-risk. That made a huge impression on me,” Rockefeller said. “Children long to grow and blossom and should be given every opportunity to do so, but first, they must have the chance to put down roots. We owe it to all children to do all that we can to give them a safe, loving and permanent home. And I am
honored to be joined today by those who work tirelessly to make sure that we do just that.”
From 1988-1991, Rockefeller chaired the National Commission on Children, which aimed to improve the lives of children in America. Rockefeller noted that the Commission was instrumental in creating the Child Tax Credit, and expanding the Earned Income Tax Credit (EITC) – which together represent the most significant anti-poverty initiative in the country. Since 1987, Rockefeller has served on the Senate Finance Committee, which has given him the opportunity to strongly defend these and other programs that benefit children and working families.
We attended the Collaborative meeting on Thursday, August 29. This meeting is chaired by Secretary Kay Goodwin and at today’s meeting we were joined by DHHR Secretary Karen Bowling. The meeting began with a presentation by US Attorney for the Southern District Booth Goodwin who unveiled a new video targeting youth substance abuse prevention. The video is very well done. It is moving and tragic. You may view the video on YouTube at this address: http://youtu.be/Dr3jN6atZ44 . The video also includes commentary by Prestera’s Kim Miller, well done Kim! US Attorney Goodwin shared that he is involved in an Appalachian Substance Abuse Summit on September 25 and 26th at East Tennessee State University a collaboration of the Appalachian states. Deputy Commissioner Kim Walsh spoke about the upcoming Behavioral Health Conference and passed out the brochures. The Association was acknowledged for the presentation last month by Kathy Armentrout, Nancy Demming, and Karen Schimmel. Secretary Goodwin welcomed members to attend at anytime. We presented information on Prestera’s SAMHSA grant award. Prestera was awarded $280,000 a year for three years. The purpose of the grant is to enhance technology to develop and implement a patient portal and to expand telemedicine capabilities. Karen Yost reported that they wish to increase treatment compliance with appointments and increase treatment capability, utilization, and improve health outcomes by providing technology based treatment and a forum for communication between multiple providers and clients. They also plan to expand use of technology to the use of mobile technology (iPads/SmartPhones, etc.) instead of the bulkier, stationary technology.
On Wednesday, USC CEO Bob Williams addressed the Joint Health Committee on issues related to commitments, managed care, the history of CHMCs, substance abuse, and the behavioral health continuum of care. Tom Susman had a request from the Jeff Johnson at the Legislature to have someone present on the commitment process. I asked Bob Williams to speak to the topic. I applaud Bob’s professionalism in representing the Association at the Legislature. He spoke for about 30 minutes and took about 30 minutes worth of questions. Questions were asked by Del. Fleischauer, Del. Campbell, Del. Miller, Del Sobonya, Del. Staggers and comments on the presentation were made by Senator Stollings. The questions related to managed care, substance abuse treatment, housing for the mentally ill and specific case questions. We passed out the Crossroads Executive Summary and a document on direct commitments to CSUs. Afterwards, Bob was interviewed by Daily Mail Reporter, Zack Harold. If anyone has specific questions, feel free to give me a call.