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The Virginia Tech Tragedy: Distinguishing Mental Illness from Violence

Statement of Ken Duckworth, MD
NAMI Medical Director

April 18, 2007

The National Alliance on Mental Illness (NAMI) extends its sympathy to all the families who have lost loved ones in the terrible tragedy at the Virginia Polytechnic Institute. We are an organization of individuals and families whose lives have been affected by serious mental illnesses.

Despite media reports, Cho Seung Hui, the shooter in the tragedy, may not actually have had a serious mental illness relative to other diagnoses. But the possibility opens the door for reflection on the nature of mental illnesses—what they are and what they are not— with regard to symptoms, treatment and risks of violence.

The U.S. Surgeon General has reported that the likelihood of violence by people with mental illness is low. In fact, "the overall contribution of mental disorders to the total level of violence in society is exceptionally small." More often, people living with mental illness are the victims of violence.

Severe mental illnesses are medical illnesses. They are different from episodic conditions.  They are different from sociopathic disorders.

Acts of violence are exceptional.

Treatment works, but only if a person gets it.

Questions must be answered about whether the mental health care system responded appropriately in this case. We know that Cho Seung Hui was referred to a mental health facility for assessment. Did he receive the right treatment and follow-up? If not, why not?

NAMI offers below the federal government’s authoritative language on perceptions of violence.

Mental Illness and Violence

Surgeon General’s Report on Mental Health (1999)

www.surgeongeneral.gov/library/mentalhealth

Are people with mental disorders truly more violent? Research supports some public concerns, but the overall likelihood of violence is low.

The greatest risk of violence is from those who have dual diagnoses, i.e., individuals who have a mental disorder as well as a substance abuse disorder. There is a small elevation in risk of violence from individuals with severe mental disorders (e.g., psychosis), especially if they are noncompliant with their medication…. Yet to put this all in perspective, the overall contribution of mental disorders to the total level of violence in society is exceptionally small.

National Institute of Mental Health (2006)

http://www.nimh.nih.gov/press/schizophreniaviolence.cfm

A study of adults with schizophrenia showed that symptoms of losing contact with reality, such as delusions and hallucinations, increased the odds of serious violence nearly threefold. The odds were only about one-fourth as high in patients with symptoms of reduced emotions and behaviors, such as flat facial expression, social withdrawal, and infrequent speaking.

Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia… By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period.

The researchers found that the odds of violence also varied with factors other than psychotic symptoms. For example, serious violence was associated with depressive symptoms, conduct problems in childhood, and having been victimized, physically or sexually; minor violence was associated with co-occurring substance abuse.

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