In the UK a new – non-medically defined – personality disorder was created, after Michael Stone, was convicted of the 1996 murders of Lin and Megan Russell, and the attempted murder of Josie Russell. Five days before these killings, Stone had announced to a psychiatric nurse, that he was intending to kill his probation officer, his family, along with staff members at the psychiatric facility. In the U.S. – in most states - Stone could have been admitted/committed because, he had demonstrated that he intended to harm others; the two other criteria for such, are if the person is intending to harm themselves or is unable to look after themselves in terms of meeting basic day-to-day needs. However, in the UK, at the time, a person could only be detained if his mental health disorders could be treated – and personality disorders, such as anti-social personality disorder etc., would often fail the “treatability test(s)” as specified in the 1983 Mental Health Act.
Although personality disorders are a type of mental illness, they are often separated from illnesses, such as Bi-polar, Schizophrenia and Major Depressive Disorder because of the system patterns they cause, such as large-scale and long-term emotional shifts etc. Also, people with personality disorders tend to be able to function within society to a degree, to which those with mental illnesses can’t and don’t, such as withdrawing, and socially isolating themselves. However, after Stone’s killings there was a political effort – which almost all of the psychiatric community objected to – to extend what was understood “traditionally” to be a mental illness to include personality disorders. Part of this involved the creation/definition of a condition, referred to as “Dangerous and Severe Personality Disorder” – an extreme form of anti-social personality disorder, which contained certain features of borderline personality disorder etc. Although mental health professionals in the UK needed more tools to handle cases such as Michael Stone’s, the extension of mental illness to include personality disorders had the potential to be draconian in nature, and probably not particularly effective. In this article I want to look at the question, are people with mental illness more likely to act violently in the future?
The first question, this raises, is more violently than who? The question tends to regard society as being homogeneous i.e., that all members, apart from the mentally ill, are the same. However, this is far from the case, and society can be subdivided into many distinct groups e.g., are juvenile offenders with a history of violence, more likely to be violent than the mentally ill? Probably yes, and if we split that group by gender, we will find that men are more likely to engage in violent offending than women. Age, being young, along with gender, being male, along with having a history of violence is a much greater predictor of future violence than someone simply having a mental illness, such as schizophrenia, despite public opinion to the contrary i.e., a 2018 poll showed that 60% of Americans believed that those with schizophrenia were likely to be violent in the future. Part of this misconception comes from sensational media coverage when those with a diagnosed mental illness engage in violent acts, along with how the mentally ill are depicted in movies and TV shows. Studies, which have looked at characters in TV shows such as Law and Order, Criminal Minds, CSI etc., find that people who are verbally identified in some way as having a mental illness make up about 5% of all cast characters, but in 51% of their stories, they engage in some form of violence, as compared to 18% of non-mentally ill characters i.e., TV shows portray the mentally ill as violent. To put this in context, and compare it to reality, if all mental illnesses could be cured, not simply treated, but cured, it would result in only a 4% drop in serious violent offending i.e., 96% of all serious violent offending is carried out by people without a diagnosed mental illness (this figure does include individuals with personality disorders but as we’ve looked at before they are categorized/characterized differently).
Just as normal/general society is not comprised of identical individuals, neither are different mentally ill populations e.g., the way one person experiences schizophrenia may be very, very different to the way another person does. For instance, two people may both hear voices, however only one of them hears commands to act violently. Some people learn to manage the voices, others don’t etc. There are sufferers of schizophrenia who stay on their medications (which are largely effective), and others who don’t and choose to self-medicate using substances, such as illegal drugs and alcohol. Just as there are specific risk-factors that are applicable to people with certain mental illnesses, there are also general ones that apply as well e.g., somebody with schizophrenia who is younger is more likely to engage in violence than somebody who is older; the same for the non-mentally ill etc. Mental Illness, as a factor in terms of predicting violence should be looked at from the perspective of the symptoms the sufferer has, rather than from the diagnoses itself. To simply treat the “mentally ill” – in terms of predicting future violence - as one group, whose members all act and behave in the same way, would be completely ineffective.
The mentally ill, act as great scapegoat, when we consider incidents of violence – though this is not to say that there are none with such illnesses who engage in offending. However, often when we look at contributing factors such as substance abuse, we find that there is little difference between their offending rates and those of non-mentally ill substance abusers etc. The problem is that we often look at the illness as the main driving force in the offense, rather than the substance. The truth is that the mentally ill are more likely to be the victims of crime rather than the perpetrators, and are far more likely to self-harm than harm others.