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Preventing Violence a Concern for Mental-Health Professionals

Posted April 17, 2008
Updated April 18, 2008

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— A year ago this week, a 23-year-old Virginia Tech student killed 32 students and faculty members, wounded 25 others and then killed himself.

It spurred debate about how mental health professionals might predict and prevent such acts.

The debate comes at a time when North Carolina’s mental-health system is in a difficult transition from institutionalized care to more community-based services. The fear is that some people with severe mental illness might get lost in the shuffle – and might commit more violent acts.

Seung Hui Cho had a history of mental illness and court-mandated treatment before his fatal spree at Virginia Tech a year ago.

In 1995, Wendell Williamson had a history of mental illness before he killed two people and wounded a police officer near the University of North Carolina at Chapel Hill.

Duke medical sociologist Dr. Jeffrey Swanson says that people with mental disorders are three times more likely to commit violent acts than are others.

“It's also correct to say that the large majority of people with mental illness don't commit violent behavior,” he said.

Swanson wrote an article in the journal Psychiatric Services about managing the risk of violence as part of mental-health care.

He says there are effective medical and psychological therapies to help people with mental disorders, but for various reasons – like cost of treatment, access to care or failures in the system – not everyone gets the treatment they need.

“If they could, I think violence could be prevented, but there's also the problem that many people with severe mental illness don't necessarily want to accept treatment,” Swanson said.

How can treatment – like making sure a patient takes his or her medication–- be enforced?

“First, we have to appropriately assess who is capable of violent acts – harm to others or themselves. There needs to be appropriate follow-up, competent case workers who are in regular contact with the patients. And courts can do a lot to use leverage, not force, to make sure patients comply with treatment requirements,” said WRAL Health Team Physician Dr. Allen Mask.

If violent acts committed by the mentally ill are fairly rare, what accounts for the rest of violence in society?

“Dr. Swanson says that if we could eliminate drug and alcohol addiction, we would see violent crime go down by a third. We also have the issues of people being abused as children and children growing up in violent, impoverished environments. They're at greater risk of becoming violent adults,” Mask said.

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  • HappyGirl08 Apr 18, 2008

    Did someone pay this guy for these findings? Seriously, I can make a broad stmts like "mentally ill, 3x as likely..." w/o actually having to work that hard on it. I mean, common sense people! Common sense....

  • WXYZ Apr 18, 2008

    HMO's (aka "Health Monopoly Organizations") have quite nearly totally eliminated coverage for mental health problems from the health insurance policies, which they sell. The county, state and federal government health coverage entities have followed suit, by stopping or severely limiting coverage for mental health problems. I agree with this report that the majority of people who commit violent crimes have a history of being victims of abuse and neglect during childhood and not receiving treatment for mental health problems throughout their childhood. Generally, poor parenting and adverse community factors are a major source of children who grow up to be emotionally and behaviorally impaired and inevitbaly end up in and out or prison.

  • Zelda Apr 18, 2008

    There are two errors in this story. The first is that the transition from institutionalized care to community care came during the early 1970's. What we are facing now is the total destruction of the public, community based care (by county) in favor of private contracted care, which, of course, hasn't worked nearly as well.

    The second error is the issue of "required mental health treatment" which doesn't exist. The only thing one can require is hospitalization if a person is deemed to be a danger to self or others and people are generally discharged fairly quickly these days so very little treatment occurs in such settings. Once a person has left involuntary commitment, no treatment can be mandated, just recommended.