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Re-stigmatising the mentally ill

Just when we thought we were heading for a more tolerant and accepting attitude toward people afflicted by mental illness, a feature and a news article in Saturday’s The Australian quoting leaders in the…

By suggesting that everyone who has a mental illness could possibly be violent, the articles isolate, highlight and stigmatise them. Михал Орела/Flickr

Just when we thought we were heading for a more tolerant and accepting attitude toward people afflicted by mental illness, a feature and a news article in Saturday’s The Australian quoting leaders in the area of forensic psychiatry have revived the old mental-illness-equals-axe-murderer stigma.

One of the articles was based on a recent paper published in the journal Acta Psychiatrica Scandinavica showing a higher rate of conviction for all violent offences by people with psychiatric disorders in Victoria.

The second article examined the random attack of a stranger by a person with mental illness, which research has shown to be a rare event; most violence by mentally ill people is directed toward family and acquaintances.

Both of The Australian’s articles quoted Professor Paul Mullen and Professor James Ogloff of Monash University, who are co-authors of the Acta Psychiatrica Scandinavica study.

In 1984, Mullen wrote a paper that reported no increased risk of violence from people with a mental illness. And his 1997 review reported an increased risk of violent behaviour in a small proportion of patients. He is quoted as saying that new data has changed his views.

The newspaper articles include errors that are very damaging to the mentally ill. First, by using the umbrella term “mental illness”, they suggest that everyone with mental illness is more likely to be violent.

However, there is no increased risk of violence in most of the more common types of mental illness; the risk is almost entirely confined to a small proportion of those patients diagnosed with schizophrenia-related psychosis.

By suggesting that everyone who has a mental illness could possibly be violent (just as you and I), the articles isolate, highlight and stigmatise everyone with a mental illness, from depression and anxiety to most people with psychosis.

Most cases of more serious violence by these patients have occurred because of frightening persecutory beliefs arising from active symptoms of the illness.

The increased risk of violence in people with conditions such as bipolar disorder, on the other hand, is almost entirely due to the effects of substance abuse. And it goes without saying that violence is one of the many things people with anxiety and depression fear.

Rather than being perpetrators of violence, the mentally ill are far more likely to be its victim. This is mainly because of the disability and social disadvantage associated with being mentally ill, but also because these people are forced to associate with a small number of violent patients while in hospital.

Mental health laws in Australia detain patients in hospital after they have been deemed at risk of harm to others, rather than because they need treatment. Indeed, they do not even recognise the need for treatment.

This exposes patients who will never commit an act of violence to assault by the minority of patients who are, in fact, violent. For example, three patients have been killed in the Thomas Embling Hospital in Melbourne in as many years.

But the main omission in the two Australian articles was their failure to point out that most of the psychotic patients who committed acts of violence were not receiving treatment.

Indeed, the more serious the violence, the more likely the patient has never had the experience of remission from symptoms such as hallucinations of voices or false beliefs, or a medical explanation for their symptoms.

People with schizophrenia who are receiving treatment are rarely violent, a fact that is evident from the very low rate of violent offending by conditionally and unconditionally released forensic patients in New South Wales.

Only 12% of non-lethal serious violence by people diagnosed with psychotic illness that were dealt with in the NSW District Court, for instance, were committed by people receiving treatment at the time of their offences.

Rather than the blanket statement that the mentally ill are more violent than other members of the community, the correct conclusion is that while most people with mental illness will never commit an act of violence, people with untreated psychotic illness (and those involved in substance abuse) are more likely than the average person on the street to be seriously violent.

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20 Comments sorted by

  1. Marian Macdonald

    logged in via Facebook

    How sad. This month, it is 21 years since my brother, who suffered OCD, drowned aged 19 as a result of side effects from his medication. I often wonder what his life would be like if he were here today.

    A gentle, intelligent and very sensitive young man, he found the tight grip of his disorder so, so painful. He wondered if he would ever feel 'free' again and was worried about becoming socially isolated. Would his mates still accept him after he came out of hospital?

    We spoke of OCD at his funeral in the hope that everyone who knew Andrew would understand that even the most popular and capable kids can have a mental illness. People who are having trouble coping need our embrace rather than distance.

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    1. Alice Kelly
      Alice Kelly is a Friend of The Conversation.

      sole parent

      In reply to Marian Macdonald

      How sad Marian, I wonder if the stigma and social isolation can be as bad if not worse than the illness some have to live with. It's a pity there isn't greater understanding, I could imagine some still try to keep quiet, but I'm glad you talk about your brother.

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  2. Darren Parker

    logged in via Facebook

    I've only ever been subject to out of the blue violent attacks by strangers three times. Each time it was in the city centre and initiated by someone with clear mental health issues.

    Is this an anomoly?

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    1. Elizabeth Bathory

      9-5 project drone.

      In reply to Darren Parker

      Darren, I would like to counter your anecdote with one of my own. As a child, I was sexually abused by an older male. As a teenager, I was sexually abused by another two males, and subject to a number of indecent assaults by males. During my 29 years of life on this earth, I have been subject to countless incidences of sexual harassment, all by (you guessed it) males. By that logic, should all males be locked up as a preventative measure, as they are quite clearly predisposed to committing sexual violence?

      Forgive me answering your question with one of my own, but I feel fairly sure that this highlights the ludicrousness of your suggestion that "all people with mental illness are violent" based on three isolated events.

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    2. Darren Parker

      logged in via Facebook

      In reply to Elizabeth Bathory

      That the incidence of random violence directed at me from people with no mental health issues is 0%

      The incidence of random violence directed at me from people with mental health issues is > 0%

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    3. Elizabeth Bathory

      9-5 project drone.

      In reply to Darren Parker

      When did the author intimate that the risk of violence perpetrated by people with diagnosed mental illness was 0%?

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    4. Elizabeth Bathory

      9-5 project drone.

      In reply to Darren Parker

      Also, are you a mental health professional who is adequately trained to discern between mental health issues, and substance abuse issues? Because I believe that what the author was indicating was that there is a common conflation of mental health issues and substance abuse issues in the context of violence, and your anecdote further perpetuates that suggestion.....

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    5. Emma Anderson

      Artist and Science Junkie

      In reply to Darren Parker

      Darren

      You haven't specified the nature of those attacks (which is understandable as it is a traumatic event) and why you have interpreted the behavior as being associated with 'clear mental health issues". I take it you didn't know these perps from a bar of soap, so, what's your reasoning?

      FYI from my possibly outdated and slightly misremembered knowledge on the odds, an urban unprovoked attacked from a stranger against a male suggests two or three main (but not exclusive of other) motives…

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    6. Casey Schapel

      Social Worker

      In reply to Darren Parker

      The incidence of random violence directed at you from people outside the city centre is 0%.

      The incidence of random violence directed at you from people inside the city centre is > 0%.

      So what's your point in relation to the article?

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  3. Michael Marriott

    logged in via Twitter

    It needs to be said - but the article is from The Australian, a paper well known for both bias and filtering science through the filter of the culture war. Their article suggests it is a law-and-order issue, not that of how to treat and care for the mentally ill.

    They're reporting on a wide range of science issues is have become increasingly woeful.

    This is the inevitable result of reducing their science reporters not long ago.

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  4. Sue Ieraci

    Public hospital clinician

    Thanks for the article, Olaf.

    In my view, it informs the discussion to consider the broad causes on inter-personal violence in our society. (Without actually digging out the data), we know, for instance, that the incidence of violence, suicide and injury in general - particularly amongst young men - is much more frequently associated with alcohol and other drugs than by untreated psychotic illness.

    Ask any emergency department clinician who has worked on a Friday night what percentage of behavioural disturbance, injury and violence is fueled by alcohol and/or other drugs in comparison to schizophrenia.

    If we take the same line of thinking, should any young man who binge-drinks or takes any form of amphetamine or cocaine-like drugs be forcibly de-toxed to prevent their potential for violence?

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  5. Warren Heggarty

    Writer and Peer Worker in Mental Health at Psychosocial Rehabilitation

    The Australian Newspaper wants to treat mental illness as a law and order issue. That's makes me laugh, given the number of gunbattles in my part of Sydney lately. I have a mental illness and I am much tougher on myself than any law and order found in this country.

    I'm a journalist but I work full time with people who have a mental illness. I feel safer among the mentally ill. It becomes frustrating though, becuase many have such a low view of their own capabilities, most seem to think that they…

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    1. Sean Lamb

      Science Denier

      In reply to Warren Heggarty

      "I feel safer among the mentally ill."
      Which is why I feel so safe the company of journalists, political activists, humanitarians, foreign affairs experts and terrorism/security consultants..

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  6. Leigh Svendsen

    Industrial Officer

    Olav

    While I agree with the base premise of your article - mental illness does not mean or imply violence and should never be stigmatised - there are some matters that you need to check.

    Certainly in Victoria you cannot be 'detained a mental hospital' unless you have a treatable condition and are in fact there for treatment or at least assessment.

    And the Thomas Embling murders were committed in a secure forensic facility by people who had been detained under court order but who also had a mental illness. That is a facility specifically designed to house those who, but for their mental illness, would be in jail. So lets not confuse information that doesn't apply to the general mental health population or health service.

    Given the above two bits of information that I directly know about, I am loath to rely on the remainder of your article. I'd be happy for clarification

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    1. Elizabeth Bathory

      9-5 project drone.

      In reply to Leigh Svendsen

      Hi Leigh,

      You most certainly can be 'detained in a mental hospital' in Victoria - that's the whole premise of a Community Treatment Order. If a CTO is approved, you are legally required to seek treatment for 'mental illness', otherwise you are forcibly admitted to a psychiatric facility in order for clinicians to deliver said treatment.

      According to the following document http://www.health.vic.gov.au/mentalhealth/cpg/comm_treat_order_guidelines.pdf the following criteria must be satisfied for…

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    2. Elizabeth Bathory

      9-5 project drone.

      In reply to Elizabeth Bathory

      Sorry, I should clarify - while a CTO itself does not provide for 'forcible detention in a psychiatric facility', the decision to enact such detention can be made by a clinician if the person subject to the CTO refuses treatment.

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