I’m constantly dumbfounded by the lies and half-truths told by some who advocate on behalf of some people with mental illness. In an effort to lobby for their specific sub-group of people with mental illness, they spread ignorance and misconceptions about mental illness in general.
In a recent article one mental illness advocate wrote, he describes “myths” about mental illness that don’t actually appear to be myths, but simple truths. That is, until they are twisted by arbitrary definitions, filters, cherry-picking of data, and exclusions to fit into this person’s viewpoint.
Let’s examine these supposed myths, and see whether the data support their view.
The Arbitrary Difference Between Serious and Non-Serious Mental Illness
“Serious mental illness” is a government-defined term designed to differentiate between mental illness that “substantially interferes with or limited one or more major life activities” and those that don’t. Although some folks don’t like to admit this, the criteria do not limit serious mental illness to any specific diagnoses. If you have attention deficit disorder (ADD or ADHD) that prevents you from working, you have a serious mental illness (according to the government).
Approximately one quarter of people who have a mental illness in any given year (around 10 million adults in 2014, out of 44 million with mental illness) have one so severe that it significantly impacts their ability to fully participate in their own life. Three-quarters of those adults still potentially have a debilitating mental illness too. It’s just that the illness is currently being treated successfully enough (or is of less intensity) that it doesn’t qualify as a “serious mental illness.”
To the person experiencing a mental health issue, all mental illness is indeed “serious.” Let’s not let critics and government bureaucrats pull us into this dumb differentiation that has very little meaning (outside of government databanks). If you’re struggling with a diagnosis but can still hold down a job, that doesn’t make your diagnosis any less “serious” than a person who isn’t able to hold down a job or go to classes. I don’t care what the government says — and neither should you.
Let’s Go Back to Institutionalizing Everyone — Even Those Who Don’t Want Treatment
In graduate school I learned that a person is “allowed to be as crazy as they want to be.” That is, there’s no law against someone simply acting in a way that isn’t consistent with society’s expectations or “normal” human behavior. Or even against their family’s will. The only generally-recognized exception is when that person is an imminent danger to themselves or others.
However, some would like this to change and go back to the 1960s when you could get anyone hospitalized just for “acting crazy.” They believe that all community-based care is somehow dependent upon peer programs (huh?) or that if you have a criminal record, you wouldn’t receive care from a community mental health center. These are simply lies that aren’t based in the reality in most communities. Most communities provide people who otherwise couldn’t afford care access to evidence-based treatments, and they don’t require patients to pass a background check before treating them.
But these are the kinds of exaggerations some advocates will roll out to call for more involuntary care and treatment (under the phrase, “assisted outpatient treatment” or AOT). Could our country use more inpatient psychiatric hospital beds? Absolutely, we have a psychiatric bed shortage in the U.S. But we don’t have to discount the value and importance of everyday outpatient treatment programs and the success they’ve had in most communities for most patients.
People with Mental Illness are NOT More Likely to Be Perpetrators of Violence Than Victims
We have dozens of research studies now showing that those with a mental illness — again, all mental illness, not just some cherry-picked definition of mental illness — are far more likely to be victims of violence than perpetrators.
Some critics claim that researchers (Desmarais et al., 2014) “excluded persons with mental illness in jails, prisons and those who were involuntarily committed” in order to bias their results.
But when we reached out to researcher Sarah Desmarais, Ph.D. about the claim, she said it simply wasn’t true.
“The samples were drawn from inpatients who were being released and outpatients, many of whom could have been involuntarily committed and/or arrested and incarcerated over the course of the follow-up period or prior to study entry. Indeed, we report in the community violence paper the location of violence, which clearly indicates that our participants started or ended up in those settings.” […]
“Furthermore […], we strongly believe that equating injury and severity is a mistake. Indeed, very low severity acts can result in injury; for instance, pushing someone who trips over an object, falls and hits their head, or grabbing and leaving a bruise are much lower severity acts of violence, than are acts that include throwing an object or threatening with a weapon, even though they may not leave a mark.”
While the researchers found a tiny statistical difference between the differing rates of violence, Desmarais attributed that difference to the study’s large sample size — not as a result of any real or meaningful difference actually found (the difference between 8 and 9 percent).
Serious Mental Illness Cannot be Predicted & Prevented — Except That Research Shows That It Can
Increasingly, researchers in countries throughout the world have realized one of the keys to helping people with mental illness is doing a better job of understanding its precursors and offering preventative strategies before a full-blown diagnosis occurs. If you stop a significant portion of your population from ever getting a mental illness diagnosis, you spend a lot less in treatment services because prevention programs cost less — and don’t involve coercion, forced treatment, electroconvusive therapy, or drugs).
There are literally hundreds of research studies on the effectiveness of intervention programs to help prevent mental illness. Anyone who claims we can’t do this apparently has spent little time reading the research in this area.1 Some recent examples of research describing the outcomes of prevention programs in mental illness include Joyce et al. (2015), D’Arcy et al. (2014), Lynch et al. (2016), and the programs we described in this 2014 blog entry on the topic as it relates to schizophrenia. That’s right — we have interventions to help prevent schizophrenia before it turns into a full-blown condition.
I can see how such programs wouldn’t be of interest to someone promoting coerced or forced treatment. But researchers feel differently. Even though we don’t understand the underlying causes of mental illness, we do understand a lot about telltale signs of the illness taking hold in individuals long before it ever gets formally diagnosed. Reaching out and helping these people during this prodromal phase is important — and the scientific data shows that it helps.
Fighting for the Rights of Everyone Except the Patient
I love these kinds of advocates as much as I love a cold sore. They distort the data and research to forward their own political agenda, which is focused on forced treatment for people who don’t want it (and many who not even need it). They fight for the rights of family members, ignoring the rights of the actual people who have the mental illness. (Don’t get me wrong, I think there needs to be certain reforms to help family members get their loved ones help faster and more transparently, but these kinds of laws aren’t the answer.)
For over 20 years, we here at Psych Central recognize and fight for the individual dignity, privacy and rights of the patient. It is your treatment after all, and you should definitely have a say in it, even if your decision is to forgo treatment at a given point in your life. I don’t think scaring people with lies is the way to win anyone over.
These are no myths (so read at your own risk): Against the Grain: D. J. Jaffe’s 8 Myths About Mental Illness (Update: Sorry, we removed the link because we prefer to generally not to link to sites that spread misinformation about mental illness.)
D’Arcy, Carl; Meng, Xiangfei; (2014). Prevention of common mental disorders: Conceptual framework and effective interventions. Current Opinion in Psychiatry, 27, 294-301.
Desmarais, SL, Van Dorn, RA, Johnson, KL, Grimm, KJ, Douglas, KS, & Swartz, MS. (2014). Community Violence Perpetration and Victimization Among Adults With Mental Illnesses. American Journal of Public Health.
Elbogen EB, Johnson SC (2009) The intricate link between violence and mental disorder: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen
Psychiatry, 66, 152–161. doi: 10.1001/archgenpsychiatry.2008.537
Joyce, S.; Modini, M.; Christensen, H.; Mykletun, A.; Bryant, R.; Mitchell, P. B.; Harvey, S. B.; (2015). Workplace interventions for common mental disorders: A systematic meta-review. Psychological Medicine.
Lynch et al. (2016)> Early detection, intervention, and prevention of psychosis program: Community outreach and early identification at six U.S. sites. Psychiatric Services, 67, 510-515.
Monahan J, Steadman H, Silver E, Appelbaum P. (2001). Rethinking risk assessment: The macarthur study of mental disorder and violence. Oxford University Press, New York.
Van Dorn RA, Volavka J, Johnson N. (2012). Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol, 47, 487-503.
- Which is particularly odd if one heads up a “science-based” think tank. [↩]