Deinstitutionalization and Mass Murder

Last week, I had the opportunity to appear live on MSNBC to discuss President Trump's statements regarding mental illness and gun violence, as well as his remarks about reopening long-term facilities for the mentally ill. Although the host attempted to pull me into a political discussion, I resisted and spoke instead about the consequences of our society's longtime neglect of the seriously and persistently mentally ill.

In the aftermath of the Dayton and El Paso shootings, a number of mental health organizations, including the American Psychiatric Association and the American Psychological Association, officially condemned President Trump's statements linking the increase in mass violence to mental illness. These organizations repeated claims that we have all heard before, i.e., the mentally ill are no more dangerous than the rest of the population, and the mentally ill are more likely to be victims rather than the perpetrators of crime.

The only problem is that these assertions are, at best, misleading and incomplete, and, at worst, wholly inaccurate.

The fact is that the untreated seriously mentally ill are at an increased risk for violence, and that those with untreated serious mental disease perpetrate a sizable percentage of mass violence. While statistics vary, research shows that between one-third and one-half of all mass killings are perpetrated by the untreated seriously mentally ill (see Torrey, 2015). These individuals are also responsible for about 10% of all homicides (Matejowski, Cullen, & Solomon, 2008). Studies also indicate that once the seriously ill are treated, the incidence of violent behavior decreases significantly (see, for example, Fazel, Zetterqvist, Larsson, Långström, & Lichtenstein, 2014).

E. Fuller Torrey, M.D., the prominent psychiatrist and schizophrenia researcher, published a paper in 2015 titled “Deinstitutionalization and the Rise of Violence” which concluded that the mass closure of U.S. state hospitals in the 1970s and 1980s is definitively linked to the rise of violence in American society. Dr. Torrey also wrote a well-informed op-ed in the Wall Street Journal after the Dayton and El Paso shootings reiterating this fact.

A shuttered building on the campus of Westborough State Hospital in Westborough, Massachusetts.

Source: Tim Pierce, used with permission.

In the 1950s, more than half a million Americans were hospitalized in state mental hospitals. Today, we have a mere 35,000 state hospital beds, and gaining admission to a hospital has become near-impossible. Hospitalizations on general inpatient psychiatry units nowadays last only three to seven days. The grossly underfunded community mental health centers do their best under difficult circumstances, but the seriously mentally ill are largely going without care. Outpatient commitment is uncommon and underutilized. Instead of 600,000 in state hospitals, we now have 350,000 seriously ill in prison and another 250,000 homeless. Our mental health system has failed. Miserably.

While destigmatizing serious mental illness is a noble goal, to deny its link to violence is to do the seriously mentally ill and their families a grave disservice. It is also factually inaccurate. While the problem of mass violence is a complicated and multifactorial one, providing adequate care for the most seriously ill will go far in reducing the rate of violence in our society.