It’s wrong to stigmatize the mentally ill as violent

U.S. Rep. Tim Murphy first unveiled his mental health reform legislation (Helping Families in Mental Health Crisis Act) after what he stated was a yearlong investigation into “the nation’s broken mental health system” following the school shooting tragedy in Newtown, Conn., in December 2012. Mr. Murphy’s bill and his Jan. 15 Forum commentary (“A Grim Reminder of Our Broken Mental Health System”) unfortunately conflate the link between mental illness and violence.

The validity of risk assessment for predicting and preventing violence (especially homicide) is not established. It has been introduced into mental health care not because of scientific evidence but because of social and political factors, especially excessive, exaggerated and distorted media coverage of fairly small numbers of catastrophic events.

The vast majority of mentally ill persons are not violent. Only 4 percent of violent crimes are related to mental illness. The lifetime prevalence of violence among people with mental illness is about 16 percent, compared with 7 percent among nonmentally ill individuals. The proportion of “high-risk” mentally ill people (having risk factors for homicide) who will go on to kill someone is extremely low.

People with mental illness are far more likely to be victims of violence than perpetrators. Alcohol and drug abuse are much more likely to be associated with violence than are mental illnesses. Non-mentally ill people abusing alcohol or drugs are more than six times as likely as non-substance-abusing persons to commit violence. A substantially greater tragedy associated with mental illness is suicide. Unlike homicide, suicide is strongly associated with mental illness. More than 90 percent of persons who commit suicide have a mental illness.

Mr. Murphy’s comments are disproportionately focused on risk for violence among individuals with mental illness. Such comments contribute to a frightening but illusory aura of dangerousness that surrounds people with mental illness, adding an additional layer of stigma to individuals who are too often marginalized and isolated within our society. ROBERT H. HOWLAND,

M.D. Associate Professor of

Psychiatry University of Pittsburgh

School of Medicine Western Psychiatric Institute and Clinic

Oakland