Mental illness and violence are often hand in hand, but it can be difficult to predict whether or not a mentally ill person is violent or not. Dr. Shane Dodd, a forensic psychologist is a doctor who specializes in determining the difference. Read on for more information about the link between mental illness and violence.
HOW DO WE DISTINGUISH BETWEEN MENTAL ILLNESS AND SIMPLY BAD BEHAVIOR?
It is an important distinction which is sometimes difficult to make. Mental health conditions are disorders that affect your mood, emotions, thinking and behavior. The Diagnostic and Statistical Manual (DSM-5) is a widely accepted handbook which uses descriptions and other criteria to help health care professionals diagnose mental conditions. There is a general consensus that if bad behavior interferes with the person’s social, occupational and relationship functions, then it may be related to a mental condition.
IS DEPRESSION THE MOST COMMON MENTAL ILLNESS FOR BLACK PEOPLE?
Rates of mental illnesses in African-American communities are similar to those of the general population. 6.9% of adults in the U.S., or 16 million people, had at least one major depressive episode in the past year. Depression is the second most common mental condition after anxiety disorders.
WHO IS MOST AT RISK FOR DANGEROUS OR VIOLENT BEHAVIOR?
Most individuals with mental illness are not dangerous. People with serious mental illness are victims of violent acts more than they commit them. It is estimated that mentally ill individuals commit less than 10% of all violent acts. Most acts of violence are committed by individuals who are not mentally ill.
A male substance abuser who is not being treated poses the greatest threat for violent behavior. When mentally ill people become violent, risk factors for violence include: Past acts of violence, the presence of psychosis (such as command hallucinations or paranoid delusions), untreated mental symptoms, history of prior suicide attempts, male, young age, low IQ, single relationship status, antisocial behavior, dysfunctional family and a history of trauma/abuse.
WHO IS MOST AT RISK TO BECOME A VICTIM OF VIOLENCE?
As with any most others trends in violence, research shows that violence occurs most often within shared communities. When violence due to mental illness becomes a problem, individuals in the immediate social circle of the person suffering from psychosis or other mental symptoms are most at risk.
WHAT ARE SOME COMMON MENTAL ILLNESSES WITHIN OUR COMMUNITY THAT ARE OFTEN OVERLOOKED?
Research shows that as much as 30% of all Black women have experienced symptoms of Post-Traumatic Stress Disorder (PTSD) at some point in their lives. It is a mental health condition that’s triggered by experiencing or witnessing a terrifying incident. It could occur after being in a car accident or experiencing domestic abuse or sexual assault.
Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts or re-living the event. The exposure to violence in inner city communities is pandemic, many times placing our children in the crossfire. The cumulative impact of exposure to gun violence, racial aggression, and television coverage of violent crimes can have a substantial impact adults as well as our children. It places them at risk for future substance abuse and mental health challenges.
WHAT IS FORENSIC PSYCHIATRY?
Forensic psychiatry is a sub-specialty that deals with the interface between mental health and the legal system. A forensic psychiatrist may be involved in evaluating a defendant to address a legal issue such as advising the court if that person meets criteria for legal insanity, or address if the defendant is competent to stand trial. Legal insanity deals with the person’s mental state at the time of the offense.
Competence to stand trial focuses on the person’s current mental state and the ability to proceed with their legal case. A Forensic Psychiatrist may also provide treatment for individuals found legally insane or incompetent to proceed to trial. Lastly, we work closely with the court system to provide expert witness testimony to address issues related to potential for violence, either to themselves or the community.
ANXIETY SEEMS TO BE A MORE COMMON SUBJECT THESE DAYS – HOW CAN WE IDENTIFY ANXIETY BEFORE IT BECOMES AN ATTACK?
Anxiety is a natural, normal response to potential threats, which places your body into a heightened state of being. It can evoke a “fight or flight” response and trigger a flood of stress hormones like cortisol designed to enhance your speed, reflexes, heart rate, and circulation. Anxiety disorders are the most common mental illnesses in America. They affect around 20 percent of the population at any given time. There are many types of anxiety disorders, such as panic attacks, Obsessive Compulsive Disorder (OCD) and social anxiety.
There is no one cause for anxiety, but it is thought to be due to a combination of factors which involve negative emotions such a fear, dread and apprehension. It can be mild or severe and debilitating. Anxiety can be genetic, learned and /or be caused by psychological and environmental factors. Awareness is essential. Seeking treatment for anxiety is crucial. Effective treatments for anxiety disorders include medications and psychotherapy. Maintaining a good diet, exercise and getting enough sleep are all known to decrease symptoms in people with anxiety disorders.
WHEN SHOULD PARENTS BE CONCERNED ABOUT POSSIBLE MENTAL ILLNESS IN THEIR CHILDREN?
One half of all lifetime occurrences of mental illness start by the age of 15. Behavioral changes are often the first sign of problems. The child may show a change in sleep pattern or appetite, withdraw socially, and show new signs of unrealistic fears, sadness /crying and self-destructive behavior.
The child can even show signs of regression and return to more child-like behaviors, such a bed wetting. Early intervention is important. Should a parent have suspicions that a child is struggling, it would be important to partner with other professionals. Talk to the child’s doctor about observations or behavioral reports from others. Also speak to the child’s teacher. Learn all that you can about the behavior and refer to a specialist if needed. Each child is different and not all childhood problems are serious or lifelong.
MENTAL ILLNESS IS NOT A COMMON CONVERSATION IN BLACK HOUSEHOLDS – HOW CAN WE CHANGE THIS?
Similar to disparities in the overall physical health of Black America, many of us have not placed value on our mental wellbeing. How we interpret mental health varies according to ethnicity. A 2010 study found that European-Americans expressed beliefs about mental illness in a medical perspective and sought treatment by mental health providers.
It also found that African and Latin Americans expressed mental illness in non-medical ways, such as being related to morality, spirituality and social explanations. When faced with mental health crises, ethnic minority groups tended to refer to primary care physicians, social supports, clergy or people who speak their native language.
Ethnic minorities tend to delay treatment by mental health professionals until the symptoms have progressed in severity. It also revealed a difference in how we describe our symptoms. African, Latin and Chinese-American individuals tend to express mental distress in physical terms, such as chest tightness, dizziness or fatigue.
Change starts with improving the therapeutic experience for the individual in culturally competent treatment environments. In addition, revealing success stories could encourage other to seek treatment and share their stories with family and friends. We must have honest discussions and avoid the, “Never let ‘em’ see you cry,” mentality, because sometimes, we need to cry.
HOW CAN WE COMMUNICATE WITH OUR FRIENDS OR FAMILY WHO ARE GOING THROUGH DEPRESSION?
We must communicate in a non-judgmental manner, where we acknowledge the individual as a person. In other words separate the person from the illness. It’s important to complement the person on their strengths and positive qualities.
It will be important to acknowledge that you can’t change them, but that it is a treatable condition. Explain to the person the standards you need him/her to meet so you can live well together. Two of the most important standards to be discussed: that your home is a safe space and that you have a plan of action to ensure the safety of your loved one or the family if threatened.
See the situation from their perspective. Because of their symptoms, they may perceive things differently than you think.
HOW CAN OUR LISTENERS GET HELP?
Law enforcement for immediate danger – Contact emergency services – 911
Emergency Department: every hospital is equipped to deal with mental health emergencies
Advocacy Groups: National Alliance for the Mentally Ill (NAMI)
The court system – some states have mental health courts
Primary Care and other physicians: for treatment or referrals to mental health providers
Community or public mental health agencies
Dr. Dodd answers your text questions below:
HOW MANY OF OUR LAW ENFORCEMENT AGENTS IN NEED TO BE SURVEYED FOR MENTAL ILLNESS?
I am not aware of the specifics of the law enforcement vetting process, but it seems that critical analysis of the personality style and screening for SERIOUS mental illness would be a part. More importantly, diversity training and culture sensitivity training would be important. A few police departments have started similar programs.
WHAT DO YOU DO WITH OLDER FEMALE FAMILY MEMBER WHO HAS BEEN DIAGNOSED AS MENTALLY ILL YET REFUSED MEDICATION ALTHOUGH THEY HAVE BEEN VIOLENT?
It sound like you recognize that you must act. Firstly, realize that any action to pursue treatment will not be met positively by your loved one and could be place a strain on the relationship. Typically, once safety becomes as issue (violence/aggression), you may have some legal footing to pursue court ordered treatment. You or others may qualify to pursue legal guardianship or power of attorney to manage her medical affairs, which could include medications and treatment. Consultation with the court or a legal professional may help.
HOW CAN I REACH THIS MORNING’S “GET WELL WEDNESDAY” GUEST DR. SHANE DODD AFTER TODAY?
I AM DEALING WITH A MENTAL HANDICAP ISSUE AND A LOT OF TIMES I’M EVEN AFRAID TO TALK TO MY PSYCHIATRIST BECAUSE OF SUICIDAL THOUGHTS.
Thanks for your honesty. It sounds like you struggle, but really want to get help. Understand that psychiatrists and other mental health professionals deal with patients with suicidal ideas on a near daily basis. There are tons of people who live with thoughts of death or dying, who never act on these thoughts. Most patients fear that revealing these personal thoughts would lead to an involuntary hospitalization. But not necessarily so. The presence of suicidal thoughts alone in the absence of a serious intent or plan of action may make your doctor better understand your needs.
DO U C AN INCREASE IN DRUG INDUCED PSYCHOSIS OR ORGANIC MENTAL ILLNESS? AND HOW DO U TELL THE DIFFERENCE?.
Studies show an increase in drug related psychosis in people with prior mental illness problems AND those with no prior history. It is sometimes difficult to know the difference, but may depend on the drug ingested. In general, people with mental illness tend to show more persistent psychosis, and, in the absence of medication, will continue to experience symptoms. Other causes for organic mental illness, such as problems related to medical conditions, is a constant issue in the field and can be validated by a medical work-up.
MY SON IS AUTISTIC AND WE LIVE IN MISSISSIPPI WHERE IT’S ALMOST IMPOSSIBLE TO GET THE APPROPRIATE CARE FOR HIM. I HATE TO MOVE FROM THE PLACE THAT HE’S ALWAYS KNOWN BUT I HAVE TO THINK ABOUT HIS FUTURE, TOO. MY QUESTION IS, WHERE IS THE BEST PLACE IN THE UNITED STATES THAT MY SON CAN RECEIVE CARE?
While I am not a child psychiatrist, I’ve heard similar stories of families struggling to match the child’s needs with the best resources. Autism support groups have been helpful for the parent’s well-being and provides a useful resource for referrals. Speaking with your child’s pediatrician, if not already done, may be helpful. You may want to contact Nationalautismresources.com. Best wishes.
MY 20 YEAR OLD DAUGHTER HAS BEEN DIAGNOSED WITH MANIC DEPRESSION SINCE SHE WAS 8 YEARS OLD. SHE’S NOT ON MEDS, NO INSURANCE & OUTTA STATE. SHE WAS ENROLLED IN SCHOOL BUT IS ON ACADEMIC SUSPENSION. I DON’T KNOW WHAT TO ADVISE HER TO DO FROM THIS POINT.
I appreciate for your commitment to the wellbeing of your child. It is one of the most difficult situations to face when you see your child struggling. If not already done, I would contact and attempt to partner with her school counselor. Colleges have health clinics with mental health support available. There may be assistance available through the Affordable Care Act. Consider contacting http://www.healthcare.gov. Good luck and never stop caring.
Dr. Shane Dodd is a board-certified psychiatrist specializing in forensic psychiatry. She provides inpatient treatment for female mentally ill criminal offenders in the state of Michigan’s women’s forensic psychiatric unit. She also provides expert witness testimony for the state’s court system. Dr. Dodd attended Spelman College and is a graduate of Howard University. She received her medical degree from the University of Michigan Medical School.
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