‘It’s not mental health’: Experts attribute rise in mass violence to ‘hate and anger’

Key takeaways:

• Although still rare, mass violence is increasing in the United States, according to a recent report.
• Blaming this increase on mental illness “is unethical and ineffective,” the authors wrote.

In the United States, mass violence has slightly increased, accounting for 1% of homicides in 2023 vs. 0.2% from 2000 to 2016, according to a report by the Medical Director Institute of the National Council for Mental Wellbeing.

While mass shootings are “statistically rare events,” they still take a heavy toll on victims, survivors, families, communities and the economy, the authors wrote.

In the U.S., there were 645 mass shooting events, 702 related deaths and 2,844 injuries in 2021, and 689 mass shooting events, 675 related deaths and 2,689 injuries in 2022. From January to August 2023, there were 466 mass shooting events, 545 related deaths and 1,869 injuries.

Mental illness is a factor in some of these events, but despite speculation among the public and media, “it is not the main driver,” Jack Rozel, MD, MSL, DFAPA, medical director of resolve Crisis Services of University of Pittsburgh Medical Center Western Psychiatric Hospital and professor of psychiatry and law at the University of Pittsburgh, and colleagues wrote in the report.

“We know the problem is not getting better: mass killings are arguably more frequent and more severe,” Rozel told Healio. “We have further evidence that most of these events are complex and multifactorial: mental illness is neither necessary nor sufficient for violence or mass violence, despite ongoing stigma and misinformation.”

According to the authors, few people who commit acts of mass violence have a major psychiatric disorder. So, they warned against profile-based screening all people with mental health diagnoses in an effort to prevent mass violence.

“There are a very small portion of mental illnesses that do result in an increased potential for violence,” National Council Medical Director Joe Parks, MD, cochair of the Medical Director Institute (MDI) and coauthor of the report, said in a related press release. “In the vast majority of mass attacks, it’s not mental health to blame, but hate and anger. Hate and anger are not mental illnesses.”

In 2021, the NIH estimated that 22.8% of all U.S. adults had a mental illness, a rate that is similar among mass violence perpetrators, the report stated.

Even though most mass violence perpetrators do not have a mental illness diagnosis, the authors said these individuals could have “difficulties, personal crises or interpersonal conflicts that could respond to mental health services and psychosocial interventions.”

“Put simply, profiling based on the presence of mental illness is unethical and ineffective, but identifying and treating mental illness in people otherwise believed to be at risk for violence is an ethical and effective strategy to reduce violence,” Rozel, Parks and colleagues wrote.

The report is an update to the MDI of the National Council for Mental Wellbeing’s 2019 report on mass violence. The authors outlined many recommendations in the new report to help prevent future events, such as:

• increasing behavioral threat assessment and management (BTAM) teams by utilizing the Bipartisan Safer Communities Act and other resources;
• implementing effective disciplinary procedures and support services in schools;
• training health care providers on lethal means reduction, “a rational strategy for reducing lethal violence, which is very helpful in combating suicide”;
• prioritizing interventions for people at higher risk for violence based on their personality traits, diagnoses or life circumstances; and
• including “harm-to-others portions” in addition to “harm-to-self portions” in risk assessments conducted by the 988 Suicide & Crisis Lifeline and similar call centers.

Rozel said that effective, multidisciplinary approaches like BTAM “are underutilized and under resourced, despite growing evidence to support their use.” Instead, ineffective and sometimes harmful practices persist, such as zero-tolerance policies in schools that often punish students for minor misbehaviors.

“We need to devote renewed energy and attention to this problem, applying evidence and professional judgment, not politics and prejudices,” he said.

Rozel encouraged psychiatrists to learn more about BTAM and “to integrate these best practices into our own clinical practice.”

“This may also include ethically and effectively responding to a request for collaboration from a BTAM team about one of our current patients or knowing when and how to reach out for support about one of our patients,” Rozel, who is a member of the Healio Psychiatry Peer Perspective Board, said. “Integrating BTAM tools and models into routine psychiatric management of violent patients is not the standard of care in clinical settings but I would argue a good case can be made that it is a best practice for many of us.”

Reference:

• Updated report reflects rise in mass violence, calls for heightened urgency in efforts to stop it. https://www.thenationalcouncil.org/news/report-rise-mass-violence-efforts-stop/. Published Dec. 10, 2024. Accessed Dec. 10, 2024.