“A murderous psychosis”: mental health and dangerousness

28 Jul
Photo credit: Sean Jones QC

Photo credit Sean Jones QC @seanjones11kbw

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You know the stereotype: the “mad axe-murderer” or “deranged maniac” who appear in the media in the extremely rare and therefore newsworthy instances where someone with serious mental illness commits a violent crime. I wrote recently about how the “unpredictable and potentially dangerous” stereotype is so accepted that it goes unnoticed, assumed to be a natural fact; how it is therefore repeated, and reinforces negative assumptions about those of us managing mental health problems in our daily lives. Almost goes unnoticed, that is, because I for one do challenge outrageously stigmatising and inaccurate stereotypes about mental ill-health when I see them. I say this sort of thing:

  1. People with mental health problems are far more likely to be victims of crime than perpetrators; and are far more likely to be victims of crime than the general population.
  2. People with serious mental illness are far more likely to take their own life than that of someone else; and the vast majority of people with serious mental illness are never violent towards others.
  3. The risk factors for violence – such as being male, having a past history of violence, or of alcohol or drug abuse – are the same as for the general population as they are for people with serious mental health problems; therefore, measures to reduce violence will be more effective if targeted at the general population, not specifically at mental health patients.
  4. Violent acts during psychosis are so extremely rare that it is not possible or practical to predict let alone prevent them – other than by measures aimed at the general population.
  5. Psychosis is causal in violent crime in a tiny minority of cases; where someone with a mental health diagnosis commits a violent crime, the mental illness causes the crime to be committed in only a tiny minority of cases. In other words, almost always, mental illness is simply another of a person’s characteristics, in the same way as diabetes or red hair.
  6. People with mental health problems are, well, people.

Yesterday, I was asked by Sean Jones QC to put my money where my mouth was and come up with research links to dispel his “murderous psychosis” stereotype that I’d just challenged. How did I know that these statements, which all contradict the stereotypical media portrayal of people with mental health problems, are true? How could I prove these points to someone who wants to know – or at least give them sufficient information so that they can go away, do their own checking and make an informed judgment for themselves?

When someone asks me what my proof is that the “murderous psychosis” stereotype is untrue, I usually refer them to organisations like Time to Change, Mind and Rethink Mental Illness. In other words, experts; organisations that make it their full-time business to know what’s what in the field of mental health.

Both are a good starting point. However, they may not satisfy someone who wants to drill down into the details themselves. Of course they could contact those organisations direct themselves, but what can I do to help? What else is there, if you want to dig a little further? Here are some more links I send to people:

Here’s more about psychosis and on still being human whilst having serious mental health problems:

  • Sometimes (I Have Schizophrenia)/All Of The Time (I’m Just Human) (3 mins). There are many more videos in Jonny Just Human, Jonny Benjamin’s YouTube channel on his experiences of schizoaffective disorder and other stuff on being human. In the words of Jonny Benjamin, “We’re not all dangerous or violent, as some papers would have you believe.”
  • Finding Mike – Short film (45 mins) including Jonny Benjamin talking about his experiences of psychosis (here’s the 50 second promo trailer).
  • Facts about psychosis from mental health charity Mind – “Psychosis (also called a psychotic experience or episode) is when you perceive or interpret events differently from people around you. This could include experiencing hallucinations, delusions or flight of ideas.”
  • A personal experience of psychosis from mental health blogger Charlotte Walker (April 2014)
  • Simon says: Psychosis! – Short film in which (amongst others) people with lived experience of psychosis talk about their experiences of psychosis in the context of receiving treatment from a particular Early Intervention in Psychosis service (June 2014)

These are all good places to start. But where else might I point people to? I’m good in 140 characters – but that’s about it. I’ve retweeted interesting studies when I’ve randomly stumbled across them, and that’s how I’ve formed my views. I’m not a mental health researcher. I’m not even organised. I don’t have access to scientific reviews behind pay walls. I haven’t been collating a database of relevant research – unless you count my list of favourites on twitter (currently running to over 2,000).

New research is published all the time but the general public (including me) will mostly only have access to press reports on the research, which typically highlight some juicy aspect to ‘sell’ the story to potential readers. I’ve also noticed that not all research is particularly good quality: sometimes research seems to ask the wrong questions; some studies look at just criminals or just people with psychosis, rather than looking at the whole population. Mostly it seems research conflates cause and correlation, simply counting violent crimes by people with mental health problems when the fact of having a mental health diagnosis (either at the time a violent act was committed or at a later assessment) does not prove that the mental health problem was the cause of the violence.  There was a US study I came across that said, in convicted violent criminals with serious mental illness, the mental illness was the cause of the offence in under 7% of cases. It was interesting because it highlighted the difference between having a mental health problem at the time of a crime and that mental health problem having been the cause of the crime. But then I lost the link to the study and haven’t been able to find it since. Like I say, I’m good in 140 characters.

Like plane crashes, “murderous psychosis” makes the headlines because it’s rare. It’s alarmist, inaccurate and causes suffering to people managing mental health problems in our daily lives. There’s ignorance about psychosis & violence, with the media stereotype we’re fed. But, when challenged, some people do want to know more.

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Update (pieces written or added since publication of this piece):

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