Americans Increasingly View People With Mental Illness as a Threat

Megan Brooks

October 10, 2019

Despite an absence of supporting evidence, Americans increasingly view people with mental illness as a threat, and many support involuntary hospitalization for such individuals, new research shows.

The increasing stigma toward people with mental illness is "concerning, as it can lead to increasing discrimination," lead author Bernice Pescosolido, PhD, distinguished professor of sociology at Indiana University in Bloomington, told Medscape Medical News.

"People with mental health problems have to face the challenges of having a major illness. The increasing stigma that we document translates into these people and their families also having to fight the rejection, isolation, and denial of civil rights that may come with an increasing negative climate of fear," said Pescosolido.

The study was published online October 7 in Health Affairs.

"Mentally Ill Monsters"

Political rhetoric regarding mass shootings that wrongly links violence to mental illness likely plays a role in the evolving public view, the researchers say.

Following the August mass shootings in El Paso, Texas, and Dayton, Ohio, President Trump said publicly that mental illness is linked to gun violence and characterized psychiatric patients as "mentally ill monsters."

In response, the American Psychiatric Association quickly issued a statement saying that the "overwhelming majority" of people with mental illness are more likely to be victims of violent crime rather than the perpetrators, as reported by Medscape Medical News.

Pescosolido and colleagues examined trends in public perceptions of violence regarding people with mental illness and in support for coerced treatment of these individuals over a 22-year period using data from three National Stigma Studies conducted in 1996, 2006, and 2018.

As part of the studies, respondents were given one of three vignettes describing people who meet clinical criteria for mental disorders or one describing a person with nonclinical "daily troubles."

Results showed a general increase over time in people's perceptions that individuals with mental disorders are dangerous. Results also indicated a general increase in support for stripping these individuals of civil rights, significantly so for individuals with schizophrenia.

By 2018, more than 60% of respondents regarded people who met criteria for schizophrenia as being dangerous to others, and 44% to 59% supported coercive treatment (either medication, forced physician visit, or hospitalization), the researchers found.

In addition, 68% of respondents in 2018 viewed people who had alcohol dependence as being dangerous to others, and 26% to 38% supported coercion.

"Lower but substantial percentages" were reported for people with depression; 30% thought that people with major depression were likely to be dangerous to others.

And "remarkably," 20% of respondents felt that individuals with nonclinical "daily troubles" were likely to pose a threat to others, they report.

Troubling Trends

Pescosolido said these results are troubling because little evidence supports the hypothesis that individuals with mental illness are more likely to commit violence.

Even more troubling, she said, is the increasing risk of using legal means to force individuals who only have problems of daily living, not mental illness, into treatment.

"Given the current state of affairs, it is critical to continue to monitor cultural attitudes, beliefs, and predispositions that link mental illness to violent behavior. The continued existence of such beliefs and their connection in the public mind to forced treatment may drive the adoption of formal public health laws that restrict the lives of people diagnosed with mental illness," the authors write.

Undertaking efforts to counteract sources of stigma is "daunting but indispensable to public health. We caution against policies based on erroneously linking mental illness and violence. Public policies stoked by political rhetoric will not improve the lives of any Americans," they conclude.

The research was supported by grants from the National Science Foundation, the Brain and Behavior Research Foundation, the Indiana Consortium for Mental Health Services Research, and the Indiana University Network Science Institute. The authors have disclosed no relevant financial relationships.

Health Aff. Published online October 7, 2019. Abstract

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