Violence and the Stigma of Mental Illness

News reports surrounding the mass shooting that left 20 elementary school children and 6 adults dead in Newtown, Conn., have speculated that the shooter may have had an autistic spectrum disorder (such as Asperger syndrome) or a psychiatric disorder. Such speculation contributes to the stigma of mental illness by associating mental illness with violent behavior and can lead many to assume incorrectly that individuals with such disorders are always violent.

In fact, there is no evidence that links autism—or any number of other psychiatric disorders—with violent behavior. Some people who suffer from an autistic spectrum disorder may have trouble controlling aggressive thoughts and behavior, but thoughts are a long way from planning and carrying out an act of mass violence. Many other factors—such as age, family challenges, and access to guns—contribute and need to be considered.

The Stigma Up Close 

Mental health experts assert that associating psychiatric disorders with extreme violence in the absence of real evidence only makes the stigma worse. These misconceptions fuel stereotypes so, when a mass shooting occurs, people quickly look for a psychiatric diagnosis to blame it on. In the aftermath of the shooting in Newtown, discussion erupted anew, implying an association between autistic spectrum disorders and violent behavior. A position paper published by Mental Health America clearly refutes this association, asserting that such attitudes are ill-informed. Moreover, these assumptions ignore distinctions among various types of mental illness—equating less severe forms, such as phobias, with more debilitating syndromes, such as schizophrenia—as though all psychiatric disorders are the same. Although a small subset of people with mental illnesses may become violent, the vast majority of people with psychiatric disorders do not. Lastly, the stigma surrounding the mentally ill overshadows the real fact that people who suffer from psychiatric disorders are much more likely to be victims rather than perpetrators of violent acts.

Misconceptions surrounding mental illness continue despite efforts to educate the public. First Lady Rosalynn Carter publicly championed efforts to promote change in the mental health field. Tipper Gore, wife of Vice President Al Gore, organized and chaired the first-ever White House Conference on Mental Health to lead an effort to destigmatize mental illness and recognize that behavioral disorders, such as depression, schizophrenia, and autism, should be treated, rather than hidden or scorned. The conference was attended by President Bill Clinton and First Lady Hillary Rodham Clinton and brought together top government officials and mental health professionals from around the country. National calls to reduce the stigma associated with mental disorders have also been issued by both President George W. Bush and the Surgeon General. Despite these initiatives, however, the stigma lingers.

Access to Care

Regardless of any mental health issues that the shooter may or may not have had, the Newtown shooting does once again bring to light the challenges of treating mental illness and early identification of potentially violent behavior. The shooting occurred at a time when states have cut a combined $1.8 billion from their non-Medicaid state mental health budgets in the past three years and eliminated 4,000 inpatient hospital beds in the past five years, according to the National Alliance for Mental Illness, making access to care even more difficult to obtain. Although the CDC estimates that as many as 25% of adults in the U.S. suffer from some form of mental illness, only about 7% received treatment in 2010.

In the wake of the Newtown shooting, President Obama promised to use “whatever power this office holds” to work with mental health experts to prevent future tragedies. Recognizing the role that mental illness may have played in mass killings in the past, some lawmakers are calling for increased funding and better access to care. Mental health advocates recommend a multifaceted approach that includes increased funding of mental health programs and better mental health benefits through the Affordable Care Act. At a minimum, the recent shootings in Newtown may make cuts to mental health services less likely in the current fiscal negotiations in Congress.

What Nurses Can Do

The first thing each nurse can do is to examine his or her own preconceived ideas and fears about patients with a psychiatric diagnosis. Although some may believe that these individuals may be violent, others may feel that they are lazy or calling for attention. A self-aware, educated nurse does not allow such fears and misconceptions to interfere with the nurse-patient relationship.

Although more research is needed to establish best practices, nurses have an opportunity to make an impact. For example, nurses can take the lead by playing an active role in advocating for change and fair treatment of people with psychiatric disorders. Direct-care nurses can advocate for patients who do not receive the full scope of treatment. Nurse researchers and advanced nurse practitioners can design, evaluate, and implement theory-based stigma-reducing interventions. All nurses can contribute by becoming involved in antistigma organizations and recruiting colleagues to help.

Because nurses often facilitate communication among various healthcare disciplines, they can use this skill to facilitate dialogue to reduce stigma. And they can make their voices heard when mental illnesses are misrepresented in the media. The nursing profession holds a special place in the public trust, thus affording nurse professionals a strong voice in making a positive impact on public opinion.

To learn more about evidence-based practices in ensuring safety while providing optimal care to patients with psychiatric emergencies, look into the Mosby’s eLearning course, ENA: Handling Psychiatric Emergencies.

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