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

Diversity, Culture, and Mental Health

Diverse Populations and Mental Health

July is the American Psychiatric Association’s Diversity Mental Health Month, a time to appreciate the diversity among us and to focus on the unique mental health issues of diverse populations and efforts to reduce mental health disparities.  It’s clear we live in an increasingly diverse society, but how does that diversity relate to mental health and receiving quality mental health services?

Cultural background, including race/ethnicity and other aspects, can greatly influence how we think and feel about mental health and illness, how we experience symptoms, how we communicate about mental illness, and how and where we seek help.  Some people may be reluctant to talk about mental health concerns out of fear or shame, some people may seek help from faith leaders, while others may turn to a family doctor or a mental health professional.  (See the infographic from APA:  Mental Health and Diverse Populations.)

Extensive research tells us that ethnic and racial disparities in mental health care exist. A new report from Substance Abuse and Mental Health Services Administration (SAMHSA) notes that among adults with mental illness, whites, American Indian/Alaska Natives, and adults reporting two or more races reported higher mental health service use than black, Asian, and Hispanic adults. (See chart.)
Being aware of differences in the use of mental health services among different ethnic/racial population groups is critical for mental health professionals. That is part of what Diversity Mental Health Month is about – increasing understanding among psychiatrists about the influences of cultural diversity in their practices.

The SAMHSA report also looked at why people don’t use mental health services.  Adults across all racial/ethnic groups cited the same reason most frequently for not using mental health services:  the cost of services cost or lack of insurance.  Other reasons included:  low perceived need; stigma; and structural barriers. Concern about whether mental health services would help was the least cited reason by all racial/ethnic groups.

The top barrier to care, cost, may at least be partly addressed as more people gain access to mental health care with the Affordable Care Act and the Mental Health Parity Act. Many organizations, including the APA, are working to improve cultural sensitivity and to reduce the stigma of mental health, particularly among racial and ethnic minority populations.

By Ranna Parekh, M.D., M.P.H., Director
APA Division of Diversity and Health Equity

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Marijuana: Legal Doesn’t Mean Safe

Twenty-three states and the District of Columbia have laws legalizing some form of marijuana use, and recreational use of marijuana is legal in four states and D.C.

Does this growing trend to legalize marijuana mean we don’t need to worry about it?  About one in 10 people who try marijuana will become addicted to it which means that they most likely will use it in increasing quantities, develop tolerance (less effect from it as time goes on), will have withdrawal symptoms if they try to stop, and will find that the marijuana use is causing them to neglect other important areas of their life like work, relationships and leisure activities. 

Even occasional use of marijuana can have negative effects.  hen someone has marijuana in his/her system, short term memory is impaired, reflexes are impaired and judgment is impaired.  These impairments can last 24 hours or longer after the use of the marijuana so it is certainly not safe to drive after using marijuana. Most people will not be able to perform other demanding tasks (work-related activities, childcare) at the level they are accustomed to after using marijuana. 

All the evidence that we now have indicates that marijuana is possibly permanently damaging to the developing adolescent brain. All children should be strongly discouraged from using it at all until they are at least 21 years of age. If marijuana is smoked there are also potential physical health risks, such as damage to the lungs or cardiovascular system.

For more information, see American Psychiatric Association’s  Resource Document on Marijuana as Medicine.

By Andrew Saxon, MD

Professor and Director, Addiction Psychiatry Residency Program

University of Washington

Director, Center of Excellence in Substance Abuse Treatment and Education

VA Puget Sound Health Care System

Seattle, WA

Transgender: A Diverse Group of Individuals

With the recent spotlight on people who identify as transgender, it’s important to keep in mind that transgender people are as diverse as the general population and express themselves in a number of ways.

On a very basic level, a transgender person is born as male or female, but identifies as either the opposite gender, both genders, or no gender at all.  Some who are labeled as transgender may also decide not to even use that term. There is plenty of evidence that transgender people have existed as long as there has been a concept of male and female. Only recently have they received enough support from society to express themselves in a more open way.  This new recognition and support has opened the door for transgender people to pursue life in a body that feels on the outside the way they have always felt inside.

People who identify as transgender usually start to notice their differences early in life. However people can identify and come to understand themselves to be transgender at any point during their life.  Along the lines of discovering one’s sexual orientation, there are no clear “rules,” and identifying as a transgender individual is a very personal and unique process.  This means that those who identify as transgender may decide to dress as the opposite gender, take hormones to change their bodies, and even have surgical procedures to change their appearance to fit how they feel on the inside. There are also many transgender people who decide that these options are not right for them and express themselves in other ways.

Because society has traditionally been unaccepting to those who identify as transgender, they are at higher risk of depression, anxiety, substance abuse and even suicide. Symptoms can generally improve once the person is in a more supportive and accepting environment. Being supportive can be as simple as using the person’s preferred name and pronoun. Traditionally, even this level of support has not been reached in the health care industry because lack of education and training. It’s important that health care providers become more educated about this diverse group of individuals so that all transgender people can receive appropriate health care for their minds and bodies.

For more information on the historical and psychological evolution of transgender Individuals, please see Association for Gay and Lesbian Psychiatrists (AGLP).
More information and medical guidelines can be found at World Professional Association for Transgender Health (WPATH), www.wpath.org/

By Eric Yarbrough, M.D.
President, Association of Gay and Lesbian Psychiatrists
Director of Psychiatric Services, Callen-Lorde Community Health Center
New York City

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Human Trafficking: Modern Day Slavery

Human trafficking is one of the fastest-growing global crimes according to the United Nations. No country is immune to this modern-day slavery. According to one estimate, some 15,000 people are trafficked each year in the U.S. for either forced labor or sexual exploitation. Though governments across the world have declared slavery illegal, more than 20 million people worldwide are victims of forced labor. Human trafficking is the second largest source of illegal income, second only to drug trafficking. This inhumane business cuts across gender, age and ethnicity.

A number of factors—poverty, child abuse, adverse social conditions, gender inequality—make people susceptible to trafficking. Children and youth are among the most vulnerable. Long and short-term physical and mental torture endured by victims leads to many health consequences. Physical health consequences can include traumatic brain injuries and other physical injuries, gastrointestinal problems, infectious diseases, poor nutrition, and reproductive health problems. Psychological consequences can include shame, grief, fear, distrust, self-blame and self-hatred, drug and alcohol addiction, suicide, suicidal thoughts, and post-traumatic stress disorder (PTSD).

Though this business operates in our communities, we don’t see these victims in day-to-day life as they are often kept behind locked doors. However, there are things we can do to fight human trafficking—educate ourselves, spread the word, become involved with groups fighting human trafficking and, take a closer look in our communities. With little knowledge about the human trafficking indicators and few follow-up questions, one can identify incidences of victimization and report them to the relevant authorities. Below is a list of indicators and questions from the U.S. Department of State which may help spot a victim.

Human Trafficking Indicators

   • Living with employer
   • Poor living conditions
   • Multiple people in cramped space
   • Inability to speak to individual alone
   • Answers appear to be scripted and rehearsed
   • Employer is holding identity documents
   • Signs of physical abuse
   • Submissive or fearful
   • Unpaid or paid very little
   • Under 18 and in prostitution

Questions to Ask

Assuming you have the opportunity to speak with a potential victim privately and without jeopardizing the victim’s safety because the trafficker is watching, here are some sample questions to ask to follow up on concerns:
• Can you leave your job if you want to?
• Can you come and go as you please?
• Have you been hurt or threatened if you tried to leave?
• Has your family been threatened?
• Do you live with your employer?
• Where do you sleep and eat?
• Are you in debt to your employer?
• Do you have your passport/identification? Who has it?

For more information, visit Stop the Traffik, a global movement of activists working to stop human trafficking.


By
Sejal Petal, Sr. Program Coordinator, and
Ranna Parekh, M.D., M.P.H., Director
APA Division of Diversity and Health Equity

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.