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Health Team

Preventing Violence a Concern for Mental-Health Professionals

Posted April 17, 2008 2:31 p.m. EDT
Updated April 18, 2008 2:56 p.m. EDT

— 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.