Mental Illness Alone is Not a Risk for Gun Violence

While media coverage of gun violence often leaves us with the perception of close link between violence and mental illness, extensive research tells us that many other factors are associated with a greater risk of gun violence. Most people with mental illness are not violent, and most violent acts are committed by people without mental illness.


New research adds to the wealth of evidence that mental illness is not a risk for gun violence. Research published in June in Psychiatric Services in Advance  found that prior violence, substance abuse, and early trauma are more likely to contribute to future violence than mental illness. The study authors conclude that public safety will not be improved by policies “shaped by highly publicized but infrequent instances of gun violence toward strangers.”


A 2006 report from the Institute of Medicine concludes that "… the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population."


People with mental illness are far more likely to be victims of violence—people with serious mental illness are more than 10 times more likely to be

victims of violence than the general public.



And while mental illness is not a major risk factor for gun violence, mental illness is a significant risk factor for suicide.  Some 39,000 people die by suicide in the United States each year—more than 50 percent by firearm (56 percent of men and 31 percent of women), according to the Centers for Disease Control and Prevention.  Among the major risk factors for suicide are a prior suicide attempt, substance misuse, mood disorders (depression or bipolar disorder), and access to lethal means.  However, research has also identified key protective factors—factors that make it less likely that a person will attempt or die by suicide.  Protective factors include effective mental health care and connection to family, friends and community.


By Deborah Cohen, senior writer, American Psychiatric Association

Native Americans and Suicide

By Arshya
Vahabzadeh, MD & Brad Zehring, DO





 Mental illness does not discriminate - it affects every age, sex, religion, and ethnic group.

The Indian Health Service conducted a study in 2008 that noted that the rate of suicide for American Indians and Alaska Natives is higher than any ethnic group within the United States. The study reported that suicide in these populations is up to 70% higher, especially in ages 10 to 24. Sadly, this statistic is not decreasing. Mental health professionals and society need to recognize the etiology of the despair that leads to suicide so that treatment and appropriate allocation of resources can be made.

The statistics are alarming, but possibly more alarming is the silence around this tragedy. Since suicide is taboo on most reservations - there are reports that a death by suicide often is not reported or legal authorities classify it as an accident. Due to the silence and misrepresentation, the numbers could be even greater.



It is important to break the silence on the troubling trends within Native American reservations. Native Americans must be willing to discuss their stressors and be open to getting education necessary to cope, deal, and treat their stressors. Mental Health professionals must be willing to understand their culture and adapt. Alex Crosby, MD, MPH, medical epidemiologist of the CDC has been recorded as saying that Native American suicide is so prevalent that it has become acceptable practice when tensions build up. Suicide should never be an acceptable option.



Reasons for troubling trends among Native Americans

There are a lot of thoughts on why mental illness and suicide have increased in the Native American population. There has been a lot of discussion of generational trauma due to the disempowerment and oppression of Native Americans and Alaska Natives. It has been discussed that this has caused adverse childhood experiences that lead to high rates of depression and other mental illness that are precursors to suicide.

While disempowerment and oppression could very well be contributing factors - poverty seems to be a growing problem on reservations. Poverty tends to put stress on educational standards decreasing the educational opportunities for those on the reservation – leading to a viscous cycle. There are few jobs on the reservation causing adolescents and young adults to leave their families and move to where there are jobs. However, parents age and get ill causing tension between the traditional Native American family structures where youth takes care of the elderly and providing for the immediate family.

In addition to poverty, substance abuse is a big problem on the reservation. Substance abuse can affect mood, often negatively, which increases the tension and is a risk factor for suicide. Domestic violence and sexual assault are also known problems on the reservation. These stressors have led to unstable environments for children growing up. Add untreated mental illness to the mix and it is easy to see how hopelessness and despair thrive often leading to the belief that suicide is the only way out.

The Way Forward

Recently, the American Foundation for Suicide Prevention joined a Native American Mental Health panel sponsored by Congressional Native American Caucus and Center for Native American Youth. The panel focused on ways of improving mental health resources and suicide prevention. The IHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on targeted suicide prevention programs. The IHS established the Suicide Prevention Initiative and SAMHSA provided funding to the IHS to address youth suicide and provide suicide prevention for high-risk populations.

As we move forward as Mental Health professionals, it will be important to continue to collaborate with the Native American population, especially with Mental Health professionals with experience with the population and their culture. Understanding their culture and etiology of stressors will go a long way in providing the appropriate resources and treatment.

Resources for Help

In the US:

·         Suicide help

·         1-800-273-TALK



Outside the US:

·         International Association of Suicide Prevention (IASP)

Adult Bullying in the Workplace

By Brad Zehring, DO

I would rather be a
little nobody, then to be an evil somebody - Abraham Lincoln

Typically, when bullying is talked about it is in the
context of children or adolescents during some level of schooling. Rarely do we
think about bullying as an adult issue. However, much more attention has been
focused on adult bullying – more specifically, adult bullying in the workplace.

According to various sources, citing research and survey’s, it
has been reported that as many as 1 in 4 adults will face some form of bullying
in their career.  It is important to
point out the differences between constructive criticism, workplace conflict,
and bullying. Workplace bullying focuses on the person rather than the
performance or task being completed by the person. In addition, the person
being targeted feels powerless to stop it. Making the situation worse, is when
the adult being bullied goes to management to report the offense and the abuse
is minimized or discounted altogether. Complicating the issue further is the
difficulty verbalizing what is taking place or being unaware that what is
occurring is bullying, leading to worsening suffering.

What are some forms
of workplace bullying?

As discussed earlier, workplace bullying can be described as
an extreme pattern where the person is isolated apart from his/her performance
or task. Some examples of workplace bullying are: being left-out of
work-related social events, coworkers refusing to help when asked, coworkers
leaving the room when you enter or routinely arriving to meetings late that
when you call them, being yelled at, put down, or disciplined in front of your
coworkers. These are some of the ways that workplace bullying presents, but it
is not an exhaustive list.

How workplace
bullying is harmful

For individuals who are being bullied in the workplace,
their desire to go into work day after day is diminished and their satisfaction
in their performance and with their employer decreases.  Many reports discuss the loss of productivity
when job satisfaction decreases. Beyond the psychological stress (depression,
anxiety, PTSD, etc) – which should not be minimized, stress from bullying can
lead to physical illness such as stroke, heart attacks, chronic fatigue or dissatisfaction
in an person’s personal life – including leading to suicide. There are many reports
documenting poor job satisfaction negatively affecting all areas on one’s life.
Feeling accomplished and satisfied in a career can lead to a happier personal
life and vice versa.



How to prevent or
deal with workplace bullying

While recognizing or speaking up about workplace bullying
can be a difficult task - it is important not to be silent about bullying experiences,
whether personal attacks or witnessed attacks on colleagues, or isolate from
those that may be able to help. Currently, states are working on anti-bullying
bills to encourage healthy workplace environments, but fostering a workplace
for your coworkers that doesn’t tolerate bullying is key. Many organizations
provide or contract with mental health professionals willing to discuss,
advise, and help an individual navigate the process. It is important to
document your concerns and be specific and concise with the message you are
trying to convey if you feel you are being bullied. Despite how difficult it
may be, it is important to approach the bully or go to your supervisor with a
calm demeanor and discuss your concerns rationally. Lastly, it is important to
have an open mind about the situation. Sometimes it may be that the “bully”
does not realize how his/her actions have affected you. Approaching them, or
the situation, calmly will provide an environment for understanding and
increase the probability for change.

How to "Bully-Proof " Kids

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Williams’ death reminds us that a patient’s relief might be a warning sign

By
H. Steven Moffic, MD

One
of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by
exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name.
Sometimes, I played the audio over and over, as if it could promise a good day.
As he did so often, he found a way to not only lighten the sadness, but to do
it in such a way that might be constructively critical.

Surely,
the real life mornings were not often happy ones, as so many of our troops died
or ended up with post-traumatic stress disorder (PTSD) from that war. It is a
lesson we are still learning, so that movie and his role is worth seeing again
soon.

Now,
after his reported suicide, that good morning seems more like a final good
night.

Although
he is probably best known for his manic comedy, he also played many serious
roles. Most ironically now, he won an academy award in 1997 for playing an
empathic therapist in the film “Good Will Hunting.”

Indeed,
beloved entertainers like Robin Williams have a therapeutic role of sorts for
society in the sense that they provide some relief—even if briefly—for the
grief and stress of everyday life. For playing that societal role, such people
become a repository for our hopes, dreams and demons. As we know for so many
famous entertainers, it is not easy for them to have a successful private
life—a private life that the public also tries to invade, as if they were
related to us.

What
we do know publicly is that Williams suffered from chronic depression and
intermittent substance abuse. It is reported that he received treatment,
including entering rehab just last month. Obviously, money to get the best
treatment was not an issue, though how good the treatment was will remain
unknown. We do know, however, that wealthy VIPs often receive treatment just as
poor as low-income folks without resources. We also know that occasionally
depression is a terminal illness, though that ending is not predictable.

Beyond
the public information, and despite the understandable curiosity, this is not
the time, nor should it ever be the time, to speculate about his diagnosis and
reasons for committing suicide. In fact, the so-called "Goldwater
Rule," called that for the inappropriate professional speculation about
presidential candidate Barry Goldwater, ethically prohibits such speculations
on the part of psychiatrists like myself.


Given
this professional ethical principle, as well as the family's request for
privacy, is there anything we can still learn from this apparent tragedy? The
most intriguing detail that caught my attention was his last tweet and
Instagram on July 31. Reportedly, he had wished his daughter a happy 25th
birthday.

Why
might this positive communication be of importance to us?

It
reminded me of the only patient I ever had who committed suicide, long ago,
when I was a resident in training. In the second session, the depression of
this elderly man seemed to be less severe, but after that session he walked
into Lake Michigan and drown. In the psychological autopsy, I never forgot the
warning that when a depressed patient starts to seem better, they actually can
be at higher risk for suicide.

Risky
time

Why
is that time of apparent improvement a risky time? The person can have more
energy, then plan and complete a suicide. They may also feel relief at their
decision, causing others to paradoxically feel relief. That is one of the
reasons why it is so common to hear of the genuine surprise that the suicide
occurred, as the person seemed to be happier.

What
this means, not only for professionals, but for the public, is not to take at
face value if a depressed person seems better. Be sure there is a sound
explanation for the apparent improvement. 

Our
only consolation must be that entertainers like Robin Williams keep on living
in the form of their life’s work, like the movie “Good Morning, Vietnam,” that
is so ubiquitously available nowadays. Even so, it would not be surprising if
at the times we laugh once again at Robin William's humor, that the laughter
will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral
Healthcare, and The Hastings Center's Over 65.



This blog was originally published in Behavioral Healthcare.
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