Our nation is now engaged in a discussion about what to do in the wake of recent mass shootings. I believe such a discussion...
By Ellyn Jeager

Ellyn Jeager

Our nation is now engaged in a discussion about what to do in the wake of recent mass shootings. I believe such a discussion is essential to the overall well-being of our country.

Part of this national conversation is about legislating more gun control. But the current emphasis of the discussions, in many instances, is about legislating control of people with mental health conditions. I believe this is a bad idea.

While those of us in the mental health profession agree that more resources need to be allocated for mental health, it is imperative to understand that violence and mental health issues are two different subjects. What needs to be done to prevent violence should not, therefore, be linked to national databases of people with mental illnesses.

A database containing the names of people with mental illnesses would be impractical, stigmatizing and ineffective. There is no evidence that such a database would effectively control or limit violent behavior. People with mental health conditions are no more likely than others to commit homicides or other violent acts. Most violent crimes are committed by people who do not have a mental illness.

Would the various legislative bodies consider a database of every American citizen who might potentially commit a violent act? The Orwellian universe this suggests should horrify all of us. Why, then, should those with mental illnesses be subject to such gross violations of civil rights?

While a small number of people with untreated mental health conditions, particularly those with co-occurring and active substance abuse problems, pose a higher risk of harm to themselves or others, there is no known way of identifying which persons in this group will commit violent acts in the reasonably foreseeable future.

Additionally, individuals in this group who are most at risk of harming themselves or others are not connected to evidence-based treatment, and therefore are not connected to the treatment staff who are best equipped to make an assessment of their risk or harm.

Only people connected to a treatment system would be included in such a database. This would violate medical privacy and would have the effect of scaring people away from needed treatment. Confidentiality is essential to effective treatment and recovery.

More involuntary treatment, however, is not the answer. There is no reliable way to identify particular individuals who might harm others. We would be required to confine very large numbers of people with mental health conditions in order to achieve even a modest reduction in the risk posed.

Failure to engage people with serious mental illnesses is a service problem, not a legal one. Outpatient commitment is not a quick fix that can overcome the inadequacies of under-resourced and underperforming mental health systems. Coercion, even with judicial sanction, is not a substitute for quality services.

The problem with our mental health system is not that we fail to hospitalize people with acute mental health conditions. Rather, it is that we fail to take reasonable steps to prevent those conditions from occurring. Risk and resiliency factors are well understood, and the science behind them should be applied to our country’s public health efforts.

What we need is adequately resourced and recovery-based community care. The most effective way to reduce the risk of harm that can be posed by some people with mental health conditions is to make a comprehensive array of evidence-based, recovery-oriented community mental health services available in a timely fashion to all who need them.

In addition to treatment, those services should include supported housing, supported employment, peer support services and psychotropic medications.

Because Medicaid is the largest single source of funding for mental health services in each of the 50 states, states should be encouraged to take advantage of the Affordable Care Act’s Medicaid expansion provisions. Medicaid programs should be immediately required to fully implement Early and Periodic Screening, Diagnosis and Treatment for youth. These are the easiest short-term financial solutions to our underfunded and broken mental health system.

So, yes, let us have a national discussion about the health of our nation, but let’s make sure we do not engage in magical thinking. Rather, let us engage in ideas that come out of knowledge, reason, and compassion.



Ellyn Jeager is the director of public policy and advocacy for Mental Health America of Georgia.  She has held that position for 15 years.


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Ellyn Jeager

  • NoMoreRulers

    While Ms. Jaeger be dedicated to those with mental illness, which I admire (as I studied psychology), her appeal not only lacks statistical basis but defies basic logic. Of course violence and mental health issues are two different things but for God’s sake, tell us what mentally fit individual goes on a rampage to kill dozens of unrelated, unknown innocent people? We wouldn’t be having this discussion if it wasn’t for the last mass shootings, all of which were perpetuated by individuals with mental illness.

    Further, she states that there is “no evidence that people with mental health conditions are no more likely than others to commit homicides or violent acts?” This statement frankly stunned me, considering her position. One thing is to advocate for a position but another is to mislead to promote a position. A quick Google search found plenty of “evidence.” Here is an article http://healthland.time.com/2012/07/31/mass-murder-and-mental-illness-the-interplay-of-stigma-culture-and-disease that also includes a link to one such study that showed that people who have schizophrenia and substance-use disorder have 9 times higher risk of violence. Here is another article that quotes another recent study http://www.capitalpunishmentbook.com/?p=756 and yet another that says that over ½ of the mass shootings perpetuated by individuals with acute paranoia, delusions and our depression. http://www.motherjones.com/politics/2012/11/jared-loughner-mass-shootings-mental-illness

    Obviously, criminal background checks without mental background checks would be meaningless as they would not have stopped any of the recent mass murders. Further, since 80% of mass murderers obtained their weapons illegally (link from Mother Jones), what major impact on mass shootings will all these new gun control laws have on those who purchase guns legally? The mental health industry needs to do much better job in reporting and tracking individuals with mental illness outside background checks, since not only 80% of these perpetrators obtain weapons illegally but because over 1/2 the murders are committed with knives and other weapons besides guns. Time we stopped sacrificing our children for the possible “stigma” of labeling someone as a potential risk to themselves or others. This can/should be done with privacy but it absolutely must be done, and now.

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  • Looking For REAL Answers

    NoMore Rulers (below) has been mislead by media portrayals.

    Have you ever seen a headline that read, “Perfectly Sane Man Kills Wife”? Neither have I, but that is the norm. Sensational media coverage of the rare occurrence when a person with mental illness is violent, however, leads the uninformed public to believe that all people with psychiatric disorders are dangerous. It is simply not true.

    People with mental illnesses are far more likely to be victims than perpetrators of crime. NIMH studies have documented that 95% OF VIOLENCE IS COMMITTED BY PEOPLE WHO DO NOT HAVE A PSYCHIATRIC DISORDER.

    If you need further proof that people with mental illness are not, as a group, dangerous and violent, consider this. It is a research-ducumented fact that one in five people in the United States will have a mental illness each year. If most (or even many) of them were violent it would not be safe to go outside.

    People with mental illnesses are all around us living brave, productive lives. To call them violent when it is simply not true is both ill-informed and harmful. Good public policy must be grounded in reality.

    • NoMoreRulers

      Misled by the media? Are you saying that the media misreported the facts or that they shouldn’t have mentioned it because, it’s irrelevant? The fact that they shot dozens of people that they never met is a perfectly normal human behavior?

      Regardless, you want to dismiss the media AND all of the studies (that I provided links for) because you read that 95% of violence is committed by people that do not have disorder. But of course! Probably 95% of all violence committed in the US is also committed by people that reside in the US because probably 95% of all people currently in the US, reside in the US. Basic probability—not even close to being an argument.

      But, since you mentioned NIMH, I thought I’d check and this is what they say: “Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further.” You need to catch up on your reading…

      Alas, I never said that all people with any form of “mental illness” (anxiety, ADD, eating disorders, cognitive decline, etc.) have a greater tendency to commit violent acts. We are clearly talking about acute disorders like schizophrenia, psychotic disorders, etc. Those who treat people who suffer from the types of mental illness absolutely should be required to report individuals (that are not confined) that are have a higher probability of committing mass/random violence!

  • Osazeone

    I agree with Ms. Jeager. Our politicians are quick to scapegoat people with mental illness. People kill, not the mentally ill. People kill, not guns. How fast we as a nation forget words of wisdom and life, “violence begets violence, you don’t end violence with violence.” Dr. Martin Luther King Jr.

  • Right on!

  • I concur

  • NoMoreRulers

    How many more children have to die before you guys acknowledge that most random mass murders (by a significant large percent as shown in studies at the NIMH and endless other studies) are committed by people with serious mental illnesses?! Heck these same people that can go out there an buy guns are not even allowed scissors when institutionalized! Just a few weeks ago we almost had MORE children become victim to another acute mentailly ill individual!! Read up and get your heads out of the sand. http://www.washingtonpost.com/opinions/kathleen-parker-guns-are-a-loaded-issue-in-the-south/2013/02/15/34cd1c20-77b6-11e2-aa12-e6cf1d31106b_story.html

  • BC

    Known gun-owning misogynist; psychotic behaviors; NO MENTAL HEALTH LABEL
    Enuff said!

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  • Justanothercasualty

    I have been diagnosed with Bipolar Disorder. When I first tried to seek treatment through a state sponsored mental health service ( i was unemployed because the condition had become so overwhelming) I was summarily rejected as having any problem at all. I was spoken to in a condencending tone and refused any sort of medicine; I suspect on the strange idea that I was a drug seeker (with 0 evidence of me having any sort of addiction problem)..who seeks Seroquel anyway? The practioner took an argumentative stance with me. I was treated as if I was lying even though I was very open with the characteristics of my condition. The visit was finished up by the “mental heath practitioner” with a joke about holy water; even as I had specifically explained that my condition included very serious religious delusions.

    That meeting was a horrible experience that ultimately aggravated my condition to a point where it was hard if not impossible for me to seek out other services because that meeting perfectly supported my delusions of persecution. It wasn’t until I hit the bottom of the depression pit and ended up in a car accident that I finally was able to find a psychiatrist who had his head on straight who INSTANTLY prescribed me Seroquel (from the sample closet) of which I took my first pill in the parking lot and happily take to this day. The mental health system as well as the general health system is riddled with gross incompetence…at least in my experience. I think they have the awful advantage of who is going to believe who? I am the one with a mental health problem…so my word no longer means anything at all. Nothing good comes from silencing entire populations of people…but who am I kidding?…not listening is much easier and just as profitable if not more so in the health care system.

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