On Oct. 1, a gunman killed nine people and wounded 20 others at Umpqua Community College in southwestern Oregon. Headlines about the massacre have trumpeted mental illness as the cause. “Madman kills nine” led The New York Daily News. Fox News followed with “Issue of mental health part of national discourse again following Oregon college shooting.” “The CBS Evening News” featured “Mass shootings and the mental health connection.”
This is both the wrong explanation and a too-quick conclusion about the tragedy that contributes to the stigmatization of people with mental illness. Mental Illness Awareness Week (Oct. 4 through 10) offers an opportunity to step back and take a closer look at what mental illness is, how stigma makes it worse and what resources need to be marshaled to help those who have a mental illness.
People with some kind of mental illness account for more than a quarter of Americans and 20 percent of children. Some 18 percent of American adults experience some kind of anxiety disorder and almost 7 percent experience severe depression each year. Attention deficit hyperactivity disorder affects 4 percent of adults and 9 percent of children annually. Three percent of adults live with bipolar disorder and 1 percent with schizophrenia. Most people with mental illness function well on a daily basis: Only about 1 in 25 adults experiences an illness severe enough to interfere with daily activities.
The stigma associated with mental illness, however, prevents many people from seeking help or even acknowledging to themselves that they have an illness. Social stigma includes the popular and inaccurate stereotype associating mental illness with violent or criminal behavior. Many people don’t want someone with a mental illness living next door to them or working in the next cubicle. People with a mental illness often feel the same prejudices, blaming themselves and feeling guilty and bad because of their illness.
While the stereotype and news coverage say that mentally ill people are more likely to be violent and to be the shooters — in places such as Newtown, Connecticut; Columbine, Colorado; and Umpqua Community College — that’s simply not true. People with mental illness are more likely to be victims of violence than perpetrators. According to a study in the American Journal of Public Health, “only about 4 percent of violence in the United States can be attributed to people diagnosed with mental illness.” Other factors, especially access to guns, are more highly correlated with shootings.
After the December 2012 Newtown shooting, National Rifle Association President Wayne LaPierre advocated a national registry of people with mental illness — while adamantly opposing a registry for guns. Right-wing commentator Anne Coulter advocates locking up people who are mentally ill, writing, “Guns don’t kill people — the mentally ill do.” But other factors correlate even more strongly with being a mass shooter, including substance abuse, a history of violence and having access to guns. Vanderbilt University professor Jonathan Metzel noted, “The types of information garnered in background checks is far and away more relevant for predicting gun crime than is a person’s psychiatric history.”
If a man suffers from a broken leg, no one expects him to just fix it by himself. No one says, “You just need to work harder at having a more positive attitude.” No one tells a woman with pneumonia that she can get better with 10 easy steps described on a website. Yet these responses often meet people with diagnoses of mental illness, while treatment resources are limited or unavailable.
Only half of children with mental illnesses get treated each year, according to the National Institutes for Mental Health. Adults with serious mental illnesses get treatment at only a slightly higher rate — 58.7 percent. Older adults get treatment at much higher rates than younger adults. Only 40 percent of 18-to-25-year-olds with serious mental illness get treatment.
The first barrier to getting treatment, apart from social stigma, is lack of services. Last October, two Minnesota parents had to send their teenage son to Iowa for in-patient treatment. They tried 30 in-state facilities, but none had a bed available. The National Alliance on Mental Illness reported “a critical shortage of qualified mental health personnel — from psychiatrists and nurses to social workers and other direct service providers.”
Cost is another barrier. Half the adults who need but do not get mental health services say they just can’t afford it. Over and over, insurance companies outright refuse coverage for necessary care. Sometimes co-pays are so high that people can’t afford to get therapy. Or insurance companies set payment rates so low that mental health providers won’t accept the coverage.
Many people with mental illnesses cycle through the criminal justice system. They may be repeatedly arrested but never get treatment. As many as half of prison inmates suffer from some kind of mental illness, with about 17 percent having very serious mental illnesses. Most get little or no treatment.
Meeting mental health needs requires increasing availability of treatment and funding to pay for that treatment. State and federal governments need to fully fund school mental health services as well as increase funding for residential treatment facilities, community mental health centers and mental health services for inmates of prisons and jails.
Ending stigma presents as big a challenge as moving governments and insurers. Former U.S. Rep. Patrick Kennedy helped break the silence imposed by fear and stigma, writing about his and his family’s struggles with mental illness and addiction. “We have to eradicate the stigma of mental illness once and for all,” he wrote, “and treat mental illness equal to other physical illnesses, so that all Americans can lead dignified lives and share in the benefits of our society.”
People with mental illness are family members, neighbors, friends and co-workers. Mental illness is treatable, and people with mental illness need treatment, not social stigma and discrimination. Dispelling the stigma and providing access to treatment are challenges our society cannot afford to ignore.