The Erroneous Link Between Mental Illness and Violence

Our mental health coverage in 2024 is made possible by the Minnesota Association for Children's Mental Health.

In a National Alliance of Mental Illness (NAMI) online discussion on January 18, guest speaker Eric Elbogen, psychiatry professor at Duke University and clinical psychologist for more than 30 years, spoke about his research at the intersection of law and mental health. He talked about how violence is often instinctively — in people’s minds and media reports after a notable shooting — linked to mental illness, “but the vast majority of people with mental illness are peaceful and nonviolent.”

A year ago, Elbogen said, someone in Texas took hostages at a synagogue. In the first 24 hours, news outlets were reporting his brother had indicated he had mental health issues — but the person actually had a criminal record selling drugs, and extremist and angry views, which is not the same as mental illness. By the time the details came to light, people were not paying attention to the story.

In Uvalde, Texas, where the second-worst school shooting occurred a year ago, mental illness was blamed. But the shooter had just turned 18 and immediately bought weapons; he was a member of online hate groups. 

For violence to occur, Elbogen said, it is much less a symptom of mental illness than it is a mindset of hatred, behavior that is focused on crime, and an inability to feel empathy. The exaggerated sense that someone with mental illness is violent comes from speculation after a story makes headlines. Perpetrators are not evaluated in the moment; it often takes days for the media to share more about the motivations and backgrounds behind the crime. By the time the actual truth comes out, it is less newsworthy.

Elbogen said it is as if people pick up one piece of a jigsaw puzzle and think they have solved it. “When tragedy happens, people think fast, they are emotional and non-reflective. They want a quick and clear answer. But violence has many factors — not a single cause. That gets missed. Each act of violence is like a puzzle of multiple pieces.”

What is most troublesome, he warned, is that the exaggerated link to mental illness “de-emphasizes and takes attention away from other risk factors that are actually stronger. History of criminal behavior, financial instability, not keeping guns safe, being male, antisocial personality traits — those are stronger predictors of violent behavior. But they don’t make it to those headlines.”

Elbogen said people tend to blame the person and not the environment around the person. In a research study, a third of the connection to mental illness was “due to stressful life events and lack of social support” — not mental illness in isolation.

The gold standard study, he said, is the MacArthur Violence Risk Assessment Study, which interviewed people at psychiatric hospitals in different states every 10 weeks over a long period of time, along with records of criminal arrest, self-reporting, family reporting, and clinician reports. In nine out of 10 cases, people who exhibit psychotic symptoms did not act violently unless other risk factors were involved: childhood abuse, low-income vulnerabilities, being victimized. Studies also show that people without mental illness are more likely to engage in stalking than those with psychotic disorders.

The point he wanted to stress, Elbogen said, is that we are focused on mental illness as being key to  violence prevention — but it accounts for only five percent of the violence. 

Traits of Mass Shooters

What Helps Reduce Violent Crime

  • In a randomized trial, high school students in high-violence neighborhoods were given a summer job. Of that random sample group, over 1.5 years, those with a job were 43 percent less likely to be involved in violent behavior than those who did not have the job. “There is a ton of research on family interventions that can be used to curb violence,” Elbogen said.
  • In another study, in a city neighborhood with residents below the poverty line, random vacant lots were chosen. “In some of those lots, they did nothing. The other half of those lots, they planted trees, grass, and got rid of trash.” After a year of maintenance, the study found that the proclivity toward violence was reduced in those areas where people planted trees.”
  • Elbogen said waiting periods and background checks are associated strongly with reduced homicides.
  • Alcohol is strongly related to violence. In a large review of published studies, of the more than 28,000 homicide offenders across nine countries, more than one-third were intoxicated at the time of the offense.

“Some people seem to like to blame the mental health system, but that downplays the role of stronger factors, like anger and hate, criminal thinking, younger age, substance abuse, being male, and access to guns,” Elbogen concluded, inviting listeners to help change that narrative.

We will be talking about re-imagining public safety at the April 13 event. Consider joining us as a Badass member if you would like to be part of a collective statewide discussion about next steps in changing narratives.