Wednesday, September 14, 2005

TAC’s stance on talking about violent episodes

Yesterday's post on violence coincided with a thoughtful email we received from someone questioning why the Treatment Advocacy Center talks about violent episodes. We removed only the emailer's name and identifying information.

The email:

I totally support the Treatment Advocacy Center's desire to obtain legislation in all 50 states requiring "assisted treatment" for the mentally ill but I am getting disgusted at the misrepresentation of violence and mental illness. The statistics are that the seriously mentally ill constitute 5-6% of the United States population and they commit 4-5% of violent crimes (I use homicide as the basis).

SOME ELEMENTS of the Treatment Advocacy Center use "1000 homicides a year" as a sensationalist approach to getting assisted treatment legislation without putting the figure in the total perspective of the percentage of the general population. I am bitter because I feel that this does the same disservice [to] the mentally ill that Alfred Hitchcock's movie "Psycho" did for the mentally ill.

The basic predictors for violence among the mentally ill appear to be the same as in the general population: alcohol or drug abuse and a previous history of violent behavior. My support for assisted treatment is simply humanitarian reasons - to ensure that people who cannot take care of themselves and who lack the basic cognitive skills to understand this fact get into appropriate settings and on appropriate medications, for the same reason we treat a well established biological brain disease, Alzheimer's disease, this way.

TAC’s response:

Thank you for thoughtfully expressing your concern about the violence issue. This is a very difficult issue, but it is not one we can afford to ignore.

TAC is very concerned about the consequences of non-treatment. It is well documented that one of the consequences of non-treatment is harmful behavior. We would not be credible if we discussed other consequences of non-treatment (such as homelessness, hospitalization, victimization or suicide) and ignored violence.

In fact, I believe we would do a disservice to people with mental illnesses, their families and others if we did not discuss this issue intelligently. Stories about random acts of violence involving people with severe mental illnesses appear in papers literally every day.

TAC attempts to educate media, the public and policymakers that it is not all people with mental illness, but rather those who are not getting the treatment that they need, who are most often the perpetrators of such violence. That approach does more to reduce stigma that ignoring the problem.

Similarly, it is a disservice to families -- I know of too many cases in which mental health professionals dismissed families' concerns about a loved one becoming violent, so that those families were not prepared when their loved one did hurt themselves or someone else.

Assisted outpatient treatment has been shown to reduce violent behavior. Researchers in North Carolina found that people who had long-term court orders (at least 6 months) combined with regular mental health services (3 or more service contacts per month) were 50% less likely to be violent. Similarly in New York, Kendra’s Law resulted in dramatic reductions in the incidence of harmful behaviors for AOT recipients at six months in AOT as compared to a similar period of time prior to the court order. Among individuals participating in AOT: 55 percent fewer recipients engaged in suicide attempts or physical harm to self; 47 percent fewer physically harmed others; 46 percent fewer damaged or destroyed property; and 43 percent fewer threatened physical harm to others. Overall, the average decrease in harmful behaviors was 44 percent. This is information that must be shared.

I applaud your support for assisted treatment for "humanitarian reasons." We share your goals and take your concerns seriously. It is our intention to educate the public, media and policymakers about all of the consequences of non-treatment so that people with SMI can get the support and treatment they need and deserve.

Thank you again for sharing your thoughts and for your advocacy.

Mary Zdanowicz, Executive Director

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