The following piece published on the the website of the Vermont Department of Mental Health offers valuable insight that can help us resist the urge to entertain one-dimensional solutions to the increase in violent and antisocial behaviors across our country.
In the current climate where people are trying desperately to understand the violence of and reasons behind school shootings, a number of statements have been made that suggest mental health treatment is the sole answer. It is important to understand that mental health and behavior may be interrelated, but one is not because of the other. Addressing mental health alone is absolutely not the answer.
Instead, we need a variety of approaches to address these concerning situations. Likewise, it is not just about the gun debate, the availability of mental health treatment, the effectiveness of our laws, prevention, etc. We need a multidimensional approach to find ways to strengthen families to help mitigate childhood stressors and exposure to negative events so children, as they grow into adulthood, have skills and people to reach out to in a time of need.
In our commitment to address school and youth violence we must recognize the roles of many including families, schools, law enforcement, mental health providers, human service providers, child welfare and others all of which contribute to positive development of social-emotional skills in children.
Mental health and mental illness
It’s important to understand there is a difference between mental health and mental illness. We all have mental health, just like we have physical health. And we have mental health to varying degrees. We can exhibit symptoms of poor mental health and not reach the threshold of being diagnosed with a mental health condition or mental illness. We can recover from a mental illness.
Through appropriate treatment we can minimize the impact a mental illness has on our lives. We can build resiliency to help support optimal mental health. Just like exercising helps your body, building skills and relationships to deal with adversity builds positive mental health. Some people experience a mental health condition to the point they are considered mentally ill. Just like other health illnesses, mental illness can have a wide continuum of symptoms and varying degrees of impact on one’s life. When a person is diagnosed with something more severe like schizophrenia or bi-polar disorder, a diagnosis that has a higher likelihood of impacting one’s ability to function well at different points in his or her life, we describe the person as having a mental illness.
Other mental health diagnoses are not necessarily seen as mental illnesses, because their symptoms can be well managed. A well-managed mental condition, like someone who has a physical ailment that is well-treated, can stave off the development of a more serious illness in the future.
What does the data say?
People with mental illness are up to 5 times more likely to be the victim of a crime than to commit one. Only 3% to 5% of all violence is attributable to a person with a serious mental illness. The impression that must be corrected is society’s far too often labeling of people who engage in violent behavior as “mentally ill.” The vast majority of tragic events have not been perpetrated by individuals with a mental illness. In fact, they are much more likely to have been the result of individuals with some or many of the other factors described below.
Maladaptive and violent behaviors
There are people who have developed ways of getting their needs met that may have been effective for the situation they were in, yet generalizing those behaviors across settings is not socially acceptable. These individuals may have little or no concerns for others’ feelings or needs, make dramatic statementsor gestures to gain a specific response from people, or threaten or engage in self-harm to get their desired response.
For people who struggle with these maladaptive ways of getting their needs met, there is considerable evidence that shows psychiatric hospitalization and medications have limited, if any, impact on their behavior. There may be options to address the negative behaviors, especially if identified early, but traditional treatment such as therapy, medication, inpatient hospitalization or residential care are mostly ineffective. To the extent such options are employed, they definitely should not be used alone and must be in conjunction with other responses such as developing coping skills, learning anger management, addressing isolation and hopelessness, among others.
Other factors are more likely to influence negative behavior by the individual, either towards themselves or towards others. Such as:
- Anger control issues
- Isolation and feeling alone
- Feeling discounted from society, communities, friends and family
- Lack of skills to deal with adversity or lack of resiliency skills
- Feeling there are no opportunities
- Feeling there is nowhere to turn
- Feeling entitled
- Feeling treated unfairly
- A lack of meaning in one’s life.
If a person is struggling with a mental health condition; and they are the victim of bullying or harassment, have little or no social supports/are isolated, feel that his or her social/economic status is not going to change, or has come from a family where mental health or addictions are an issue; just treating the person’s mental health condition alone will not attain the desired positive change as long as the other factors still exist and are not addressed. One could argue that a person with these factors could become more dangerous if the only thing addressed is the mental health condition, as the person will likely become more energized and the stresses would continue and their frustration/anger with their situation may overflow.
Describing this as a mental health issue furthers the stigma that people with mental health issues are violent. That is not true, but people experiencing the factors described in this document and unhealthy mental health can contribute to acting out behavior including violence. Society does not have a way of discussing abhorrent behavior, and when behavior seems “unthinkable” to the common person, it is described as a mental health issue due to the general lack of understanding that bad, scary, and “unthinkable” behaviors happen and are perpetrated by people with maladaptive ways of interacting with society and not because they have a mental illness.
What can mental health treatment do?
Mental Health treatment has countless benefits; however, it is not a magic panacea or cure for all of society’s ills. For those who struggle with managing conflicts, stress, emotional upheaval, and other issues; mental health treatment can help people develop the skills to better manage these conflicts, stresses and emotions. Mental Health treatment can help those with serious and persistent mental illness (i.e. Schizophrenia, Bipolar Disorder, etc.) live safely and often independently outside of institutions. Examples of services mental health providers can offer include:
- Assess for mental health conditions
- Develop and make recommendations for treatment options
- Provide treatment to address the identified mental health issues
- Help individuals identify the areas they want to focus on to have a more successful and fulfilling life
- Work on skill development to deal with emotional stressors
- Work with team members to better understand how to respond to mental health and emotional stressors
- Work with team members to provide a comprehensive coordinated plan of care
- Work with families to gain skills necessary to address mental health and emotional stressors for their child and for themselves to reduce parenting stress
- Offer consultation to other settings where individuals spend time such as schools, employment, child care settings, primary care, first responders etc.
- Help individuals connect with other services such as mentors, housing supports, employment services etc.
- Connect with other health care professionals to make sure the whole person’s health is considered and treated.
Individuals will also need positive opportunities, job skills, educational alternatives, mentors and other supportive adults in their lives, positive family climates, positive school climates, access to healthy activities, resiliency skills, and skills to regulate emotions in order to make positive changes. Individuals need to be ready for change and there are several steps to reaching readiness, from not even thinking about change, to considering it, to actually taking steps to change. This positive change cannot come solely from supports, the individual has to be committed to making changes. And if the individual is a younger child, the involvement of his or her primary caregiver and family is essential.
In our complicated society we often wish we could point to an all-knowing answer to solve issues such as violence in communities. It is not that simple. If we think there is one single answer, we are wrong and we will never change what is happening. We need to understand this is a multidimensional problem that requires a multidimensional response. Collaboration and teaming is key in order to address this societal crisis.