In the wake of mass shootings and other tragedies, a frequent refrain is: Why don’t we get those dangerous people off the streets? And, just as frequently, people suggest that mental health treatment is the answer.
Yet, for two main reasons, mental health treatment is not an easy solution to violence. The process of treating mental illness is difficult and complicated. More importantly, the vast majority of people with mental illnesses are not violent and the vast majority of lethal acts of violence are not perpetrated by people with mental illnesses.
I am a forensic psychologist and professor of psychology. I have studied mental illness, violence and mental health treatment at length. Here are some reasons that mental health treatment is not going to “cure” violence.
Identifying symptoms of mental illness
Recognizing that someone is experiencing mental health problems is a necessary first step to treatment. This requires that either someone recognizes and discloses his or her own symptoms of mental illness, or that others identify a person’s symptoms.
People may not want to come forward with their symptoms because of stigma and concerns that friends and others will view them as dangerous. They also may not recognize that they have a mental illness. Indeed, lack of insight or unawareness of symptoms is a feature of many serious mental illnesses, such as schizophrenia or bipolar disorder.
Alternatively, mental health and other professionals can use universal screening protocols to screen everyone in a given setting, such as a school, workplace or doctor’s office, for symptoms of mental illness. These are short questionnaires that survey a range of symptoms that may indicate the presence of mental illness.
A positive screen does not mean that someone has a mental illness, however. It means that he or she may be at risk. To be diagnosed after a positive screen, that person would have to receive an in-depth evaluation by a health care professional.
Routine screening requires a place of regular contact. Federal laws mandate that Medicaid-eligible children are screened for mental health conditions and recommend screening in schools more generally. The American Academy of Pediatrics also recommends routine screening of children and youth in primary care settings.
But many schools and primary care offices don’t conduct routine mental health screening. Even when they do, they are not equipped with the skills or resources to follow up with comprehensive mental health treatment.
Challenges to providing treatment
Providing mental health care is not necessarily a straightforward task. People with mental illnesses may not want to seek treatment, and family, friends or teachers can’t simply force them to go. People with mental illnesses also have the legal right to refuse treatment, except in severe cases.
In such cases, discussion typically turns to involuntary treatment. Every state has civil commitment laws that establish criteria for determining when involuntary treatment is appropriate.
Although the specific legal standards vary by state, these laws generally describe criteria relating to the physical danger a person presents to himself or herself or to others due to a mental illness. In other words, for someone to be treated against their will in a hospital or in the community, a mental health professional must determine that: a) the person is suffering from a serious mental illness; b) he or she presents a serious, typically physical, threat to himself, herself or others; and c) that the threat is due to the mental illness.
Civil commitment is a legal process. There are two key points here. First, if the threat to self or others cannot be attributed to serious mental illness, then involuntary treatment standards do not apply. Second, a caregiver cannot make this decision; it must be made by a court. People looking for solutions to violence should not overlook these points.