Violence is a Public Health, Not a Mental Health, Problem

We were all understandably shocked by the horrifying shooting in Tucson AZ this past weekend.  A Congresswoman was critically injured, and six people, including a nine year old girl, were killed.

Media commentators have asked an important question – are public officials safe from violence anymore?  As a former public official who received threats of violence, that's a question about which I care personally.

There’s a consensus answer to it.  In our vitriolic political environment, hateful rhetoric sometimes pushes disturbed, paranoid people over the edge.  If we dial back the rhetoric and keep a closer eye on disturbed, paranoid people, we’ll all be okay.

But there’s a more important question we’re forgetting to ask that leads to a far different answer.

Who points a gun at an innocent nine year old and coldly pulls the trigger?

Tim and Mayor Paul Gionfriddo, Middletown CT Sidewalk Sale 1990, c.Hartford Courant

The answer to the question doesn’t fit easily into the narrative of this tragedy.   This is because shooters of nine year olds aren’t usually stoked by hateful rhetoric.  And shooters far more often target innocent nine year olds, who trust us to protect them, than they do equally innocent public officials.  

Think about this:

·        A nine year old was shot dead inside his Washington DC apartment in November, 2009, when a gunman fired through the front door. 

·        A nine year old boy was shot and injured in Brooklyn NY in June, 2010, in a dispute over a stolen bike.

·        A nine year old boy was shot and killed in an affluent gated community in Dade County FL in March, 2010.  A family member was the first identified as a "person of interest.”

·         A nine year old girl, playing on the sidewalk outside her aunt’s home in York PA, was shot in the back and killed in a drive-by shooting on Mother’s Day in May, 2010.

·         A nine year old girl was shot and killed while jumping rope in her grandmother’s front yard in Chicago IL in August, 2010.  Her seven year old sister was also shot. 

·         A nine year old Baton Rouge LA girl was shot six times as she got ready for school, and her mother was killed, in a home invasion in September, 2010.

·         A nine year old girl was shot and killed in October, 2010 while sitting in her family’s minivan in a parking lot in Davie FL.

·         A nine year old girl in Hercules CA was shot and hospitalized in critical condition when she opened her front door in December, 2010.

These are just some of the nine year olds who were recently shot in our country.  How big would the list grow if we added a longer time period, more ages, and additional weapons?  It’s not hard to imagine, because we have the data.  In 2002 alone, homicides took the lives of 250 children aged 4-11.

The reasons for these crimes – vigilantism, gang violence, family feuds, retribution, theft – are as varied as the lives of our neighbors.  These and other environmental demons are far, far more often the reasons why nine year olds get shot than are the illnesses of our brains. 

People with mental illness are more likely to be the victims of violence than its perpetrators.  A history of violence, juvenile detention, and physical abuse are stronger predictors of future violent behavior than is mental illness, but media stories linking mental illness and violence have created the mythical “paranoid, violent, mentally ill person” for people to fear – a myth the weekend shooter happened to fit. 

The poor link between mental illness and violence is not just my opinion.  You can read about it in the Federal Substance Abuse and Mental Health Services Administration Center (SAMHSA) fact sheet

Violence and Mental Illness: The Facts.

Violence is a public health problem in our country.  It makes our living environment more dangerous, and shortens our lifespan.  When violence leads to sudden death, most victims can be called innocent bystanders. 

No one deserves to be shot or killed – not a Congresswoman or a child, not six people on a sunny Saturday in Arizona, not the eight children listed above, not the 250 4-11 year olds killed in 2002, and not the 4,090 children and adults killed in 2008 alone in the sixteen states participating in the CDC National Violent Death Reporting System.

Our understanding of violence as a public health problem dates back only about thirty years.  Today, we need to understand that the threat of violence is much bigger than the threat posed by one gunman in a single time and place.

Until we appreciate that we have put nine year olds in harm’s way no matter where they live, learn, and play, we will fail to learn the real lesson from the weekend’s tragedy.  We are all responsible for this environment of violence, and we had better start working together to clean up our mess before more children die.

Posted by Paul Gionfriddo at

What Americans Really Think about Healthcare Reform

http://pgionfriddo.blogspot.com/2011/01/what-polls-say-about-our-attitude.html

What did the politician say after bumping his head while walking along a sidewalk as he waved to his constituents?   “I never look at the poles.”

Whether political leaders admit to looking at the polls or not, when you look beyond the headlines some current polls are saying a lot about how people feel about health and mental health policy issues. 

In the spirit of post-State of the Union bipartisanship, let’s hope that President Obama and Congressional leaders use three recent polls to listen to us about health reform, and to educate us about mental illness.

First, this is what the President and members of Congress will hear if they listen to what people are telling pollsters about the health reform law.

• We like a number of the elements of health reform, and don’t want them repealed.
• We’re not afraid that health reform will affect our existing health coverage.
• We don’t think the current law went too far.

The headlines from three January polls suggest that we remain divided about the reform law, with slightly more opposing it than favoring it. 

A Rasmussen survey found that 53% of voters favor repealing the law and 43% do not.  In the most recent ABC News/Washington Post Poll, 50% said they opposed the health reform law versus 45% who favored it.  An AP-GfK poll found the public evenly split on the new law, with 41% saying they opposed it and 40% saying they favored it. 

But when we listen beyond the headlines, we hear a different voice. 

In the AP-GfK Poll, only 26% supported repealing the law in its entirety.  An earlier Rasmussen poll also found a minority for full repeal of the law – 39%. In the ABC News/Washington Post Poll, 18% said that they favored total repeal. 

Support for full repeal isn't very high, and the reason is that we like many parts of the new law.  In the AP-GfK poll, the public supported by 50%-34% the prohibition on insurers denying coverage based on pre-existing conditions (such as cancer, mental illness, diabetes, and heart disease), and by 59%-34% the prohibition on insurers cancelling coverage because someone becomes sick.

We're also not afraid that the law is going to have an adverse effect on insurance we have and like.  In the Rasmussen poll, only 34% said that they thought the law was likely to force them to change their existing coverage.  

There are also a lot of people who think that the law should go farther.  In the ABC Poll, one in four said that the reason they opposed the law was because it didn’t go far enough.  Over half of those who supported it agreed with them, also favoring a reform law that would go farther than the current one does. 

These are a lot of numbers to absorb all at once, but the bottom line is pretty straightforward, and paints a far different picture from the headline.  35% said the law went too far, 19% said it was just right, and a slight plurality – 38% - said it didn’t go far enough. 

Politicians who ignore this message do so at their own peril. 

Second, here is why the President and members of Congress need to provide leadership in educating us about mental illness in the aftermath of the Tucson tragedy.

• We believe erroneously that mental illness causes violence. 

Some people with mental illness commit violent acts, but mental illness is not usually the reason.  One quarter of our population has a diagnosable mental illness each year, and this group is no more likely to be violent than the other three quarters.  Substance abuse (but not substance abuse treatment), juvenile detention, physical abuse, and past history of violence are predictors of future violent behavior, but mental illness is not. 

We need leaders who are willing to speak that truth to us.   

As was noted by researchers at the University of Tulsa in 2008, media reporting on events like the Tucson shooting makes a difference in how people react to the event, contributes to misperceptions about people with mental illness, and deflects attention away from the actual context of violent acts.  

Leaders need to speak up before our responses to violence do more harm than good.

In the ABC News/Washington Post Poll, 83% said that they would support increasing federal funding to add people treated for mental illness to the federal gun registry in an effort to prevent them from buying guns, and 71% said that they would support this for people treated for substance abuse.

source: ABC News/Wash Post Poll 1/11

We are so scared of mental illness that 83% of us would waste precious tax dollars creating a registry that would violate the confidentiality of one quarter of our population while doing nothing to address the real causes of violence in our society.

That’s hard to understand, but I guess we all bump into polls sometimes and come up rubbing our heads.

 

Recent "State of the Union" with DR. Fred Frese

Frederick J. Frese, Ph.D., Associate Professor of Psychiatry, Northeastern Ohio Universities College of Medicine, and RTP Steering Committee Member, was featured on CNN’s “State of the Union,” discussing the mental health aspects of the Arizona shootings.

To watch the video clip, please visit:

http://www.cnn.com/video/data/2.0/video/politics/2011/01/16/sotu.01.16.frese.earley.cnn.html