Dr Jacky Jones calls for balanced debate on violence and mental illness based on scientific fact, not primeval fear.
Are people with depression more likely to be violent than those without depression? No, they are not. Yet almost every time the Germanwings crash in the French Alps is referred to in the media, depression is also mentioned as if the two are inextricably linked.
Nearly two months after the crash, depression is the main media focus as the cause of this murder-suicide. There has been little or no attempt to analyse the facts about murder-suicide or the link, if any, between violence and depression. Twenty years of campaigning to reduce the stigma surrounding mental illness is going down the drain.
So, what are the facts about murder-suicide, violence and depression and public risk? A 2009 systematic review published in the Journal of the American Academy of Psychiatry and the Law found that the incidence of murder-suicide is extremely low and stable.
“The perception from media reports would be that the incidence is increasing greatly, but the data that we have collected show murder-suicide to be a very rare event that seems relatively constant, remaining at an overall incidence of 0.2-0.3 per 100,000 [population] a year.”
For Ireland, this works out at an average of one death a year. The incidence is so low that screening of possible perpetrators is not feasible. Nearly 100 per cent of murder-suicides are committed by male spouses/partners and almost all victims are their spouses/partners and/or children.
Estrangement, divorce or separation is a common factor, as is depression. Divorce and separation do not cause murder-suicide any more than does depression. Causation (smoking definitely causes cancer) and association (low cholesterol may improve heart health) are two different things.
A 2015 study on depression and violence published recently in Lancet Psychiatry found that the risk of violent crime was associated with depression. The researchers studied 47,158 individuals with diagnosed depression between 2001 and 2009 and compared their history of violence to 898,454 general population controls with no depression diagnosis.
During a three-year follow-up, 3.7 per cent of men and 0.5 per cent of women with depression committed a violent crime, compared to 1.2 per cent of men and 0.2 per cent of women with no depression.
The study does not establish causation or that depressed people are three times more likely to be violent. The findings mean that violent criminals are more likely to be depressed than the general population.
Blaming depression for violent behaviour does not help anyone and stigmatises mental illness. See Change, the National Stigma Reduction Partnership, is an association of 90 Irish organisations, including the Irish Farmers Association, Mabs and the Samaritans, working together to change attitudes to mental health.
Research carried out by See Change found that in 2012, the latest year for which figures are available, stigma was still around and growing. More than half of Irish adults would not want others to know about their mental health problems, while 41 per cent would hide a mental health problem from friends, up from 32 per cent in 2010.
A majority believed that being open about a mental health problem at work would have a negative effect on career prospects, up from 48 per cent in 2010. Almost a quarter believed that someone with depression would do something harmful or violent to others, up from 16 per cent in 2010.
Instinctively, human beings want to blame someone or something when perpetrators commit heinous acts, such as crashing aircraft into mountains. People feel safer if they can pinpoint causes and avoid them in future. Unfortunately, the world would not be a safer place if everyone with depression was locked up, as they were in less enlightened times.
As Prof Jim Lucey, medical director of St Patrick’s Mental Health Services, said when interviewed recently on RTÉ by Seán O’Rourke about the link between murder-suicide and violence and depression, “human beings are capable of heinous acts” and the “the murderous act of harm to others is not a feature of depression”.
Depression or no depression, human beings will continue to injure, kill and commit violent crimes. No one is ever 100 per cent safe. That is life.
However, the world has more to fear from enraged and resentful individuals than from anyone with depression and, whether we like it or not, the most dangerous place to be is the family home. Those most likely to do us harm are spouses, partners and other family members.
It is time for a balanced debate on violence and mental illness based on scientific fact, not primeval fear.
drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.
This article appeared in Irish Times on May 13th 2015: http://www.irishtimes.com/life-and-style/health-family/second-opinion-do-we-need-to-be-afraid-of-people-with-mental-health-problems-1.2202301
