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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{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} 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{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} were carried out by people diagnosed with a mental illness. (5)


  • Only about 4{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} 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{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} more likely to be victims of violence that the general public (8).


  • 85{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} 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
  • Neurological impairment
  • Paranoid delusions
  • Command hallucinations


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{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} (~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.



  1. Metzl J and MacLeish K.  Mental Illness, Mass Shootings, and the Politics of American Firearms
  2.  Johns Hopkins Center for Gun Policy and Research. Guns, public health and mental illness: an evidence-based approach for state policy (2013)
  3. 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.
  4. Appelbaum PS. Violence and mental disorders: data and public policy. Am J Psychiatry. 2006; 163(8): 1319-1321.
  5. National Center for Health Statistics
  6. Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006; 163(8): 1397-1403.
  7. Friedman R. A misguided focus on mental illness in gun control debate. New York Times, Dec. 17, 2012.
  8. 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.
  9. Papachristos AV, Braga AA, Hureau, DM. Social networks and the risk of gunshot injury. J Urban Health. 1012; 89(6): 992-1003.
  10. Hamilton B. Odds that you’ll be killed by a stranger in NYC on the decline. New York Post. January 5, 2014.
  11. 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.
  12. 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.
  13. Pueyo AA, Illescas SR. Dangerousness and violence risk assessment. Papeles del Psicologo. 2007; 28(3): 157-173.
  14. Predictor of violence among mentally ill: Lack of treatment or failure to accept treatment.



The Rope – West Virginia Behavioral Healthcare Providers Association

Addiction to drugs and alcohol affect millions of people and their families every year. Yet, they often go undiagnosed by healthcare professionals. This results in an estimated annual combined healthcare cost, lost productivity, and crime of $365 billion.

Life isn’t always easy. Drugs or alcohol may seem like an easy way to relax and forget problems. But, addiction can cause a chronic and progressive disease. Help is available.

Our association advocates for access to a broad continuum of addictions treatment services. If you or someone you know is at the end of your “rope” struggling with addictions you may contact our office or use the “find help” link on this page to locate services in your area.





Susbtance Abuse Committee Develops New Strategic Plan

Susbtance Abuse Committee Develops New Strategic Plan

Monday, August 18, 2014 Charleston, WV Today the members of the Association’s Substance Abuse Committee convened in Charleston to develop a new strategic plan.  Those present were:  Mary Aldred-Crouch (Starlight), Bob Fockler (Seneca), Donna Cooke (Logan-Mingo), Jo Ann Powell (Westbrook), Michelle Evans (Logan-Mingo), Karen Schimmel (Westbrook), Susan Coyer (Prestera), Tina Borich (Southern Highlands), Nancy Demming (Valley), Craig Curtis (Potomac Highlands Guild), Leslie Stone (Stone Strategies), Dolores Lowe and Mark Drennan (Association). The new plan will be put to print in the next two weeks along with a work plan designed for 12-18 months.  Along with the new plan the group developed a new mission statement:  “Our mission is to support & strengthen the statewide substance abuse continuum  of care through leadership and advocacy.”

The new plan highlights three target areas:

  1. Comprehensive Continuum of Care
  2. Support Policies
  3. Effective Partnerships

Our guiding principle is that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover.

Special Thanks to Leslie Stone of Stone Strategies who facilitated today’s session.


Rahall Announces $1 Million for Anti-
Drug Abuse Programs in West Virginia

Rahall Announces $1 Million for Anti-<br>Drug Abuse Programs in West Virginia

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.



Linda Rosenberg on the Passing of Robin Williams

Linda Rosenberg on the Passing of Robin Williams

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{e1be1af54d26799a927a8d0af76a8bbbfd7aef18e4219abc8118a5384db66cb5} 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.