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Roughly 20% of Americans have a diagnosed mental illness, making it a common health struggle in the United States.
It’s a general misconception that people with mental illness are prone to violence. In fact, they’re more likely to be a victim or to inflict self-harm.
Integrating mental health services into regular primary care can be an effective way to address mental illness concerns.
Uvalde. Buffalo. Orlando. Parkland. Columbine. The list of tragic events extends across the United States, and it dates back for decades. These mass shootings always prompt a conversation about why it all happens. Without fail, mental health and mental illness become a big part of the discussion.
Mental health is a nationwide concern, and it’s a widespread belief that mental illness is a driving force behind gun violence. However, the research and data show that’s not the case. In the United States, 316 people are killed or wounded every day in a gun-related incidents. But only 4% of those events are caused by a person with a mental illness alone. In many ways, this incorrect assumption makes it harder for the people who need mental health services to get them. People don’t want to be labeled as dangerous.
This month, we talked with two mental health experts from Swedish, Jenni O’Donnell, Psy.D., medical director of behavioral health integration, and Courtney Lavadia, Ph.D., a behavioral health psychologist, about the misconceptions around mental health and violence. They debunked some myths and discussed a strategy to make mental health services more readily available.
The state of mental health in America
Currently, one in five — 20% — of Americans have a mental health diagnosis with one in 25 (approximately 9.8 million people) having a serious mental illness, such as schizophrenia or bipolar disorder. Thanks to the shortage of mental health providers, though, 37% of the country doesn’t have easy access to the services they need.
It’s a growing problem, Dr. Lavadia says.
“There’s a huge gap between available licensed mental health providers and the current need that exists,” she says. “All of the things going on in the world are causing so much societal stress. Unfortunately, we can’t train people fast enough to give patients the help they need.”
Despite the widespread need for mental health services, she says, many people still actively try to avoid being diagnosed.
“We live in a world now where there is supposedly so much less mental health stigma, but there are still people who feel like they can’t go to therapy or they don’t think it’s necessary,” she explains. “So, we still have a long way to go in terms of fighting that mental health stigma, getting some of those barriers down, and making sure people have access to all of the care they need.”
Debunking the mental health myths
Even though more people are talking about mental health, there are still a few myths to clear up.
Myth No. 1: People with mental illness are more likely to engage in gun violence.
The truth is, Dr. O’Donnell says, having a mental health diagnosis doesn’t mean someone will engage in gun violence. According to the American Psychological Association, the only factor that accurately predicts violent behavior is a history of violent behavior.
“The percent of individuals with a diagnosable mental health condition who engage in gun violence is really low compared to the broader population,” she says. “There are occasions where severe mental illness contributes to homicide. But most people suffering from a mental illness are not dangerous.”
If someone with mental illness becomes violent, there’s typically something else going on, such as poverty, substance abuse, negative childhood experiences or other environmental factors. Still, any threats of violence, increasingly aggressive behavior or incidence of domestic violence should be taken seriously, she says.
Myth No. 2: People with mental illness are more likely to inflict harm on others.
It’s also a common misconception that people who have mental illness are more likely to be aggressive and hurt other people. However, the opposite is true. Not only are they more likely to self-harm, but people who have mental illness are also 11 times more likely to be victims of violence than the general population.
“People with mental health concerns are still more likely to keep to themselves and shut down,” Dr. Lavadia says.
By isolating themselves, people with mental illness frequently end up going without the medical services they need.
“They fear that sharing how they’re feeling is going to get a negative response,” she says. “They feel like they can’t talk to anybody, including their doctor or a mental health provider.”
She encourages people to reach out to a trusted friend to start getting the help they need.
Myth No. 3: People must be in a mental health crisis before seeking help.
Many people wait to seek out mental health services until their symptoms are affecting their daily lives or they’ve reached a breaking point. Waiting that long can make it harder to minimize how these conditions impact your life, Dr. O’Donnell says. Mental health services aren’t intended to be a last-resort option. Plus, they can benefit anyone.
“In reality, we could all use some level of support,” she says. “If we normalize seeking help, if we’re able to normalize talking to your physician and talking to a therapist, we can focus on things in a more preventive fashion. We could keep things from escalating to that point of crisis.”
Integrating mental health with primary care
Education is a critical part of changing how people think about mental health and mental illness, Dr. Lavadia says. Through community education programs, such as Mental Health First Aid, public health providers help people understand the signs of mental distress and teach them how to safely intervene and provide resources.
Teaching people about mental illness is only half the battle, though. Getting mental health services must get easier, she says. Instead of treating mental health care as a separate medical specialty, it should be part of the regular, routine care patients receive.
“We’re supposed to go to our primary care doctors for general screenings once a year. If we could do that with mental health, that would be wonderful,” she says. “I would love to see a switch between only going to therapy in response to trauma or crisis to also going to therapy as a preventive measure.”
To reach that goal, Swedish integrates mental health into primary care services through its Primary Care Behavioral Health model. It’s an effective way to treat a patient’s physical, as well as emotional needs, Dr. O’Donnell says.
Through close collaboration, the primary care physician, licensed mental health clinician, licensed clinical social worker, and psychologist work with patients either in person or virtually. Within two weeks, the psychiatry team can also evaluate a patient and determine if they need medication.
“This is the direction we should be going. With behavioral health care in a medical setting, we are showcasing that people can have access,” she says. “They don’t have to go to a separate building, a separate clinic, or a separate place to get the kind of overarching care they clearly need.”
This integrated approach is making mental health care more readily available, Dr. Lavadia says, but there’s still work to be done to erase the stigma around mental illness and to help people understand that these problems aren’t a red flag for violent behavior.
“This underlying assumption that if we have mental health concerns that there’s violence or aggression associated with it just isn’t always the case. Mental health concerns, in general, are so individualized,” Dr. Lavadia says. “Putting any sort of blame on mental health is like sweeping things under the rug. It creates a scapegoat for a larger conversation that needs to happen about the safety of the population in general.”
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