Assignment Help Mental Health & Gun Control
In the United States, 18,830 people were killed by homicide in 2018, with 13,958 (74%) of them being shot (Centers for Disease Control and Prevention 2020). Skeem & Mulvey (2020), reviewed the evidence base regarding mental illness, interpersonal violence, and mass shootings. The MacArthur Violence Risk Assessment Study was used by the authors to examine the discharges of patients from three acute, civil inpatient mental health facilities in the United States. (See Steadman and al., 1998). This study is particularly important because it used both official records and the self-reports of respondents to measure violence acts, which was not possible in other studies. Steadman et al. 2015 found that there were 67 acts perpetrated in interpersonal gun violence by 23 people among the 951 patients who had completed at least one follow up interview within one year after being discharged from a psychiatric facility. Nineteen of the 951 patients in the study sample were involved in gun violence that included a stranger as a victim. Within a year, 2 percent of discharged people committed violence using a gun and 1 percent were victims of violence with the gun (Steadman, et al. 2015). This is the most convincing evidence that Americans have to date showing that people with mental illnesses are not violent when using firearms against strangers.
Evidence also shows that individuals with mental illness commit certain types of violent crimes at higher rates than those who don’t have them, at least when it comes to specific diagnoses. For example, Fazel et al. Fazel et al. (2009) conducted a meta-analysis that found that schizophrenia sufferers had a 0.02 percent higher risk of homicide than those who have not been diagnosed with a mental illness. The risk of homicide in those who abuse substances was also 0.3 per cent. This means that people with schizophrenia or substance abuse were at greater risk of committing suicide than those without a diagnosis. The risk of homicide is higher among people suffering from schizophrenia. However, studies that examined violent crimes committed by people with signs of schizophrenia or similar psychoses showed that this group accounted for less than 10% of violent crimes (Fazel and al. 2009). This finding can be explained in part by the low prevalence of schizophrenia (less than 1% among the general population) (Kessler and al. 2005; Wu et. al. 2006).
About 20 percent of people suffering from mood disorders or anxiety have co-occurring drug use disorders (Grant and colleagues, 2004). The prevalence of substance abuse disorders in people with psychoses such as schizophrenia may be higher (Dixon 1999). Many people who have co-occurring mental and substance disorders abuse alcohol or drugs to cope with mental distress. Co-occurring substance abuse and dependence is often the reason for the link between mental illness, interpersonal violence, and other disorders. Fazel et. al. performed a meta-analysis on schizophrenia and interpersonal violence. Fazel et al. (2009) found that interpersonal violence was significantly higher among people with co-occurring drug abuse than it was among those without schizophrenia (random effect odds ratio = 8.9). Research using data from population-based epidemiologic research also showed a higher rate of interpersonal violence in people with substance abuse disorders (relatively to those with mental conditions or co-occurring mental disorders or those without co-occurring disorders). (See, for instance, Swanson and Johnson, 1990; Elbogen & Johnson, 2009). Fazel et. al., 2009, have called for inter-personal violence prevention strategies that specifically target substance use disorders and not mental illness.
Skem and Mulvey (2020), in their review of mass violence, concluded that around 20% of mass violence was committed by someone with a mental disorder. The authors cautioned, as they did with the suicides, about the biases in diagnosing the victims and the tautological nature of such diagnoses. Skem & Mulvey state that such diagnoses can have a circular quality. “Why did this man do that terrible thing?” Because he is mentally sick. Mass violence, which is similar to suicide, is a rare event. Therefore, it is difficult to conduct thorough, fully powered studies to identify risk factors. (See Mass Shootings in America and Smart et al. 2020). Skem and Mulvey (2020 p.92) state that “in studies that define mental illness broadly and include untrained diagnosis made in the aftermath of the rampage estimates of mass shooters with confirmed mental health problems” ranged between 30 and 60 percent. In contrast, studies that focus on formal diagnoses (e.g. from a doctor), post-event diagnoses for mental illness ranged in the range of 13 to 15%.
Research has shown that interpersonal violence is more likely to be committed by people who have mental illnesses than those without. In Chicago, for instance, 25% of those with severe mental illnesses were victims of violent crimes in a 2005 survey. This was compared to 3% of the general population (Teplin and al., 2005). Rodway et. al. (2014) presented a more complex picture of homicide victims in England and Wales. (2013) found that nearly 1,500 victims of homicide occurred between 2003-2005. Of these, 90 (or 6 percent) had received mental healthcare services within the 12 months preceding their death. The result was a higher risk of victimization than the general population. The estimated homicide victimization rate for mental health service users was 2.34 per 100,000, compared to 0.91 per 100,000 for the general population. In contrast, 213 people with mental illness were convicted for homicide during the same three year study period. 29 of the 90 victims of homicide with mental illness were also killed by the perpetrator. In 23 cases, they knew each other and 21 cases were where both were being treated at the same facility.
People with schizophrenia or related psychoses have a greater risk of committing violent crimes than those without these illnesses. However, less than 1% are likely to be involved in a firearm-related crime. These mental illnesses are rare and less than 10% of violent crimes. A co-occurring substance abuse disorder may increase the risk of violent acts in people with mental illnesses. This is comparable to individuals with no co-occurring mental disorders. Even though the evidence base is limited, it appears that people with mental illnesses may be more prevalent among those who are involved in acts of violence. However, they still make up less than one-fourth. However, victims of mental illness seem to be more vulnerable than the general population.
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