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A new study found that over the past two decades support grew for forced treatment of people with mental health issues, even if they don’t need it.
In the wake of recent mass shootings, there’s often a call to focus on the mental state of the shooter. This August, after the El Paso shooting in a Walmart and another in Dayton just days later, President Trump emphasized this concern, saying, “Mental illness and hatred pull the trigger. Not the gun.”
But research has shown that people with mental illnesses are more likely to be the victim of crimes than the perpetrators. Additionally, if the violence attributed to people with schizophrenia, bipolar disorder, and major depression was removed from national crime data, the crime rate would go down by only 4%.
One academic who has been studying mental illness and violence for decades says the way we talk about mass shootings may be making Americans more afraid of people with mental illness. “Political rhetoric is totally divorced from reality,” said Bernice Pescosolido, a sociology professor at Indiana University. Her newly published study in Health Affairs found that over a 22-year period, people increasingly perceived mentally ill people as dangerous and grew more supportive of forcing them into treatment.
For the study, researchers gave respondents short stories, three of which described a person who met the clinical criteria for a mental disorder, like schizophrenia, depression, or alcoholism, and one of which described a person with “daily troubles” who would not fit the criteria for a diagnosed mental illness. Researchers then asked participants to rate, on a scale of 0-4, how likely that person was to be violent towards others, and how much they support that person receiving coerced treatment, such as being forced to go to an institution or take medication. Every U.S. state has a law that allows for the involuntary commitment of someone who poses a danger to themselves or others.
The study was conducted in 1996, 2006, and 2018. Over time, perceptions about potential violence and support for coercion rose. It rose most significantly for people who have schizophrenia, and by 2018 over 60% of respondents saw schizophrenics as dangerous to others, and 59% supported hospitalization. People with alcoholism were also seen more negatively over time, with 68% of respondents viewing them as dangerous and 38% supporting hospitalization. Over 30% of people saw those with depression as potentially violent, and over 25% supported hospitalization.
Perhaps most surprising is how people responded to the story of someone with “daily troubles.” About 20% of people said that person posed a danger to others, and just under 20% said they should be hospitalized.
Pescosolido said that the study, which was co-authored by Bianca Manago and John Monahan, speaks to the inability of Americans to recognize mental illness and their willingness to let the medical system deal with issues that don’t fall under their control. “We’re willing to see any problem as a medical problem, even if it’s not,” she said. “Involuntary commitment is useful in some situations. But with these attitudes, we might end up coercing people into treatment who don’t need it. It speaks to how fearful of a society we’ve become.”
Because of that fear, Pescosolido said that policy discussions after mass shootings can go off track, as people imply that mental illness is the direct cause of violence. Pescosolido pointed to research from the National Council for Behavioral Health that found fewer than half of mass shooters have diagnosable mental health issues. They are more likely to be isolated, feel they aren’t respected, and have a sense that they don’t matter, which Pescosolido said “aren’t brain disorders.”
“Being troubled does not mean you have a mental illness,” she said. “But it’s like Pandora’s Box once someone mentions that a shooter might have a mental illness. You can’t take that back.”
Pescosolido also raised concerns about the way people discuss mental illness when debating so-called red flag laws, which are increasingly raised after mass shootings. Seventeen states and the District of Columbia have implemented red flag laws as a way to counteract gun violence, and several more are considering them. Though each state sets different rules, usually a red flag law allows a family member, a mental health professional, or a police officer to ask a judge to remove firearms from someone who they suspect could pose a violent risk to themselves or others. California last week expanded its red flag gun laws to expand the net of people who can file for a restraining order to include employers, coworkers, and teachers in high schools and colleges.
Although the laws are relatively new, one recent study that examined their use in Connecticut and Indiana found they were effective in reducing gun suicides. A study by the Violence Prevention Research Program at the University of California at Davis identified California’s red flag law as having played a role in preventing mass shootings in 20 specific cases they examined.
Red flag laws are supported by gun control groups, with Everytown for Gun Safety saying the group’s review of mass shootings between 2009 and 2017 found that in about half there were some kind of warning signs from the shooter before the incident.
But Pescosolido said that discussions about these laws usually fail to capture nuance—that the warning signs for a shooter are more likely to have been an air of entitlement or a sense of isolation, not a mental health issue. When red flag law debates center on mental illness, the general public begins to conflate mental illness with violence, she said. “The common sense reaction is to say ‘that person must must be sick, because how could someone who isn’t sick do something like this.’ But we’re translating ‘sick’ into mentally ill, not troubled,” she said. “Mental illness becomes a convenient scapegoat.”
Emma Coleman is the assistant editor for Route Fifty.