Does media coverage distort the link between violence and mental illness?
(April 2008 Issue)

Only a small fraction of violence can be attributed to mentally ill people, according to Janis Tondora, Ph.D. She is assistant clinical professor at the Yale Program for Recovery and Community Health. (photo by Tom Croke)

By Phyllis Hanlon

The news of the recent brutal murder of New York psychologist Kathryn Faughey sent a shiver down the collective national spine. While extensive media coverage might lead the general public to believe that violence toward therapists is common, reality tells a different story.

Janis Tondora, Ph.D., assistant clinical professor at the Yale Program for Recovery and Community Health, emphasizes that only a small fraction of violence can be attributed to people with mental illness. "But because these events are so widely publicized and sensationalized, it leads to the perception that they are more common than they really are," she says. "Media coverage can feed the idea that there is a link between serious mental illness and violence." Perpetuating this thinking creates fear and stigma, she adds.

Tondora cites a three-year, multi-site study conducted by the MacArthur Family Foundation, which concludes that "the prevalence of violence among those with a major mental disorder who did not abuse substances was indistinguishable from their non-substance abusing neighborhood controls."

Additionally, Tondora expresses her concern that sweeping legislative changes, in spite of good intentions, can backfire. "After these events, the tendency is to react. You want to do something and many will call for broad, sweeping legislation that restricts the activities of people with mental illness," she says, referring specifically to involuntary outpatient commitment, which has not yet proven to be an effective strategy in reducing violence.

"Broad laws can make people with mental illness more fearful of getting help and could drive them underground and away from treatment at a time when they most need help," she says.

Rather than reacting, Tondora recommends the implementation of some proactive measures to reduce the risk of tragedy. Citing the current fragmented system of care, she suggests instituting stronger coordination of services that includes family members. She also advises adopting best practice psychosocial rehabilitation and evidence-based treatments, all of which she sees as "grossly lacking" in the mental health system.

Tondora supports the concept of peer-based services, a relatively new idea that is gaining ground. "Research shows that engaging people into care is often most effective when done by other people who are in recovery from mental illness. They have a unique ability to connect with and support others," she says.

Christopher E. Overtree, Ph.D., director, The Psychological Services Center and associate director of clinical training at the University of Massachusetts Amherst, says that violence is not predictable and that every situation requires an individualized response.

While therapists take steps to ensure their safety, Overtree points out that it's impossible to eliminate all risk. "Unless you go to the extreme and install a metal detector, there's always a way someone can perpetrate a violent act. Any time you have interaction with the public, you are exposed to risks in the public arena," he says.

Overtree hopes this tragic incident prompts therapists to obtain more training and learn to be more discerning when accepting clients. "To reduce your exposure to risk, it's wise to pursue continuing education in managing clients with suicidal/violent tendencies," he says.

He advises psychologists who work in solo practices to think about how they would handle an escalating situation. Also, he recommends a good backup system that identifies emergency contacts in crisis situations.

Overtree adds that protecting personal information, which is so readily available today, is key. "Maintaining your privacy is getting more difficult," he says. "It makes me think twice about a home office."

Forensic psychologist Eric Mart, Ph.D., ABPP, from Manchester, N.H., admits that there has always been a certain amount of violence against psychologists from harassment to physical attack, but adds that other professions are also at similar risk. "You can get shot working in a computer store," he says.

Mart asserts that "more lethality nowadays is a contributing factor." Coupled with easy access to weapons is the reduction in funding for prevention. "Access issues and managed care are big problems," he says. "It's much harder to access treatment. And, some people might need a team of professionals, including a psychologist, psychiatrist and social worker. It's not easy to do any more."

While inpatient care might help reduce the occurrence of violent acts, Mart, who worked as a nurse's aide on a psychiatric floor before becoming a psychologist, does not promote returning to the days of "committing everyone."

Rather, he places more responsibility on the psychologist. "A trained psychologist should be aware of his feelings, such as being threatened and nervous," Mart says. "If you remain calm, you can calm an angry patient."

Mart attempts to establish rapport with clients through a "structured intake" that directly asks questions relating to arrests, self-harm behaviors and violent ideation. He suggests that psychologists raise self-awareness and becoming more attuned to the client's frame of mind. "There is a lot of talk in the profession about mindfulness in relation to therapy and patients. We should practice mindfulness as therapists," says Mart.

Donald R. Whitworth, Ph.D., professor of psychology and director of the forensic master's program at Roger Williams University in Rhode Island, seconds the importance of constant vigilance. "You can't relax," he says, citing personal experience working with homicidal clients.

While the New York incident has brought attention to safety issues, Whitworth says that many mental health professionals are already exercising caution, a factor that probably helps keep the number of violent attacks low.

Whitworth notes that post-doctoral training programs should pay more attention to the different types of clients and how to treat them effectively. More important than academic instruction is on-the-job experience. He believes using your best judgment and knowing the population you are treating serves as the best protection.

Whitworth cites certain behaviors that should raise red flags. For instance, a client who has a tendency to avoid critical issues, displays a lack of social skills or expresses fear of accessing valuable resources for cultural, familial or personal reasons might need closer evaluation. "There are a complex set of variables that interact," he says.

"We live in a judgmental society and that frightens clients away," says Whitworth, citing the importance of respect. "It's a real privilege and honor to be allowed to share [a client's] pain," he says. "If you treat it like that, progress will be made."

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