As I’ve banged the drum previously here and here about the lack of a significant relationship between violence and mental illness, I was happy to read an editorial published in today’s Boston Globe, Mentally ill unfairly portrayed as violent by Dr. Ronald Pies. He makes the point far more succinctly and strongly that I ever did — there is little relationship between violence and being mentally ill (despite media hype to the contrary), according to the scientific research.

Where a relationship does exist, it can almost always be attributed to the presence of alcohol or substance abuse — a far stronger predictor of violence (across the board, diagnosed with a mental disorder or not). But Dr. Pies does make an important point:

That said, mental disorders do increase susceptibility to substance abuse, and thus indirectly increase risk of violence. Moreover, as Eric Elbogen of University of North Carolina Chapel Hill School of Medicine wrote me in an e-mail, “. . . a subgroup of people with mental illness likely uses alcohol and drugs to ‘self-medicate’ psychiatric symptoms.” In my experience, this behavior may reflect the inadequate, fragmented care often provided to those with mental illness who also abuse drugs or alcohol so-called “dual diagnosis” patients.

Because some people with a mental disorder, especially severe ones like schizophrenia are more likely to turn to illegal drugs or alcohol in an attempt to drown the symptoms of this disorder, they are at greater risk for violence.

And Dr. Pies nails the real problem on the head — the fragmented care system that exists today in the vast majority of states to try and help people with serious mental illness and a co-existing substance abuse or alcohol problem. Such programs are often ineffective due solely to the lack of funding and resources given to them, not because their treatments aren’t helpful.

So can we finally put this myth of some strong link between violence and mental illness to rest?