THE FEB 14 shooting in a Florida high school once again brought to the fore the issue of the relationship between mental illness and violence. US President Donald Trump felt that the shooter’s mental illness inevitably catalysed his mass killings. But what are the facts?
A 2000 article in Psychology Today entitled “Are the Mentally Ill Really Violent?’ by Edward P Mulvey and Jess Fardella, stated, “The overwhelming majority of people with diagnosed mental disorders do not engage in violence.” In fact the article pointed out, “Certain factors that appear to be associated with an increased likelihood of violence are in line with common sense’. In effect it’s the same for persons with and without mental illness.
A 1998 study published in the General Archives of Psychiatry by the MacArthur Risk Assessment Project, “shows that the circumstances in which mental patients most commonly commit violence do not differ markedly from those surrounding crimes committed by people who are not mentally ill. In both groups, violence most often arises from everyday stress, such as conflicts with spouses, family members and co-workers.” That study also found that patients discharged from psychiatric facilities, who did not abuse alcohol and illegal drugs had a rate of violence no different than that of their neighbours in the community. In fact, research indicates that fewer than 5 five per cent of gun-related killings are committed by the mentally ill.
In effect, as the American Psychiatric Association emphasised following the Florida shooting, the “disparaging and inaccurate remarks about mental illness serve only to perpetuate stigma and prohibit honest and open dialogue about an illness (or disorder) that affects one in five people in the nation.”
For people with mental illnesses such stigma makes an already difficult existent much harder. As columnist` The Mighty ‘puts it in the February 24 issue of the Huffington Post, “When you have a mental illness, you can feel utterly alone. You feel like a mime in an invisible box you can’t escape. The pain is not like that of a physical illness. The pain is deep and the sorrow or burdens hold on to you, sometimes for years. You live like that, a constant cycle of feeling like you will never get better because of what has happened or what will happen if you don’t “try harder”. Of course, part of getting better is putting work into it, but it takes a long time for some people.“ And, for some people, never.
The need to bring clarity to this issue is important given that according to a study by Dr. Bhiro Harry and others, more than 200,000 Guyanese are mentally ill. As well, there is the habitual abuse meted out to the mentally ill. This issue, often ventilated by social activists, was again raised in a February 22 column, by Freddie Kissoon, who detailed the beating of a mentally ill man by government workers who had disembarked from a garbage truck on the Camp Street seawall.
In fact, according to a WHO report released in 2014, Guyana is still struggling to fight the stigma of mental illness. Hidden or left to roam at will, the mentally ill are often abused or neglected or both. In the courts, far too often they are sentenced without any psychiatric evaluation or mandated treatment. And, the 1930 Mental Health Ordinance does not include many basic elements of protection in legislation. Nor has it ever been updated, although plans to do so were announced last year.
The WHO report adds, “Persons with mental disorders are reported to suffer discrimination in their communities, the workplace, educational institutions, judicial services and the health-care system. Safeguards to protect individuals with mental illness from involuntary admission and treatment and mechanisms to oversee treatment practices within health facilities are lacking. There are no independent review bodies established to protect the human rights of users of mental health services. Stigma against the mentally ill is reported to be pervasive and considered by stakeholders to be expressed by the public, as well as by many health professionals, the police, and policy makers and administrators alike.”
“There are no standards, protocols, policies or guidelines for the use of psychotropic medications; the assessment, treatment, monitoring, and ongoing evaluation of patients with mental disorders; the charting of patient information; or the maintenance of health records. There is little national mental health data available for mental health service monitoring and evaluation. As a consequence, datasets of sufficient quality are not available to inform service utilisation or to provide quality assurance for mental health care.”
This sober reality emphasises the need for a basket of measures for which The Caribbean Voice and others have been lobbying, including mental health care integrated into the physical health care system with psychologists in all public hospitals; the establishment of psych wards with easy accessibility, in all public hospitals, and periodic visits by psychologists to all satellite clinics and community health centres; counsellors in schools; relevant training for all police officers and guidelines for protecting the mentally ill, publicised across Guyana. As well, the ossified Mental Health Ordinance needs to be overhauled via bipartisan cooperation to avoid political footballing, so that the deficits outlined by WHO are addressed and the legislation informed by the latest advances in treatment for mental health, including the very common conditions of depression and anxiety.
In fact, advances in brain imaging indicate that the brains of persons who are clinically depressed look different than the brains of the non-depressed, similar to a diseased heart being different than a healthy heart. A combination of genetics and environment contribute to clinical depression, and episodes of depression can be triggered by traumatic experiences such as: childhood or adult physical or sexual abuse; loss of a loved one; relationship problems; unemployment; poverty; pregnancy; childbirth; a serious physical health illness such as cancer or AIDS; an accident or a natural disaster, as well as by a family history of depression; loneliness and a profound exposure to social alienation. Sometimes, however, depression can have no obvious cause at all.
Also, scientists have found specialised brain cells in mice that appear to control anxiety levels. “If we can learn enough, we can develop the tools to turn on and off the key players that regulate anxiety in people,” says Joshua Gordon, Director of the US National Institute of Mental Health. The situation is similar with respect to treatment for depression. As well, these advances open up possibilities for other mental health issues.
Meanwhile, there is still much that Guyana and Guyanese can do to address mental health. One such measure has to do with tackling the noise level. Studies in the UK and Denmark have found that living next to loud neighbours more than doubles your risk of mental illness and almost trebles the chances of suffering severe stress. Experts found rates of depression were twice as high among homeowners constantly bombarded by a racket from nearby premises. Late night parties and loud music were cited as the most common bugbears. But noise from building works was also a major catalyst. And, in the context of Guyana we might add, minibus music, rum shop music and all night parties and various celebrations.
In effect, there is need to stringently apply the laws relating to noise control across the board. As well, government and employers can provide first-aid training in mental health. Both employers and government can also ensure that mental health experts are available to assist those who may be experiencing mental health problems.
In fact, there is need for an ongoing and extensive, all stakeholders’ education campaign, not only to tackle the taboo against counselling but also to inform the population about the realities of mental illnesses so that myths and misinformation can be dispelled and needed attitudes cultivated, so that, for example, abuse of the mentally ill, whether on the streets or at home (as exemplified by the case of Gopaul Etwaroo), would cease. Also critical, is the need for a return of the Gatekeepers Programme to train lay counsellors within communities, to be proactive first responders and to keep mental health redress grounded on reality rather than sensationalism. As the WHO pointed out, “there are many non-health professional and non-professional groups in Guyana, including teachers, community leaders, traditional/spiritual healers, herbalists, religious leaders, law enforcement (police), ambulance attendants, NGOs, and the media, who could potentially play a role in the promotion of mental health in their communities”.