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Health experts: Mental illness not valid predictor of violence
Tuesday, March 07, 2000 By Sally Kalson, Post-Gazette Staff Writer
Without more information on Ronald Taylor's background, health professionals said it's impossible to say whether the mental health system operated as it should have in his case.
People who want immediate help for themselves or others should call the county's crisis hotline at 1-888-424-2287.
It's not known whether Taylor, accused in last week's shooting rampage in Wilkinsburg, had a diagnosed mental illness, if he was taking or was supposed to be taking any medication, or if he was getting any mental health services at the time of Wednesday's attack.
Taylor lived alone in an apartment in Wilkinsburg. Persons close to him said he had been hospitalized at St. Francis Medical Center for 37 days and released about six months ago, and a neighbor said he had been seeing a doctor at Allegheny East Mental Health/Mental Retardation in Wilkinsburg.
But the nature of any such treatment has not been disclosed -- and is not likely to be, given the rules of patient confidentiality.
Regardless of Taylor's condition, mental illness is no predictor of violence, according to Edward Mulvey, a psychiatrist at the University of Pittsburgh who studies violent behavior.
"Of the reported incidents of violence in our society, 5 to 10 percent of the people had a mental illness," Mulvey said. "That's small potatoes.
"Delusions and violence do sometimes overlap, and someone may be driven by illness to commit a terrible act. But the illness itself is a lousy predictor. Impulsive teen-agers with handguns are a much bigger risk."
Clinicians who try to predict violent outbreaks in any population will be wrong half the time, Mulvey said, because violence is a complicated, socially based transaction. It can be triggered by all manner of stimuli, from a perceived verbal slight to a screamed insult, if it takes place at a moment of great vulnerability.
Most mental health patients are seen in a therapist's office or hospital setting, he noted, "but the violence isn't happening there. It's happening five hours later, in a setting with family or other acquaintances, when there's an argument about the dinner check -- and that's no different than in society in general."
Events such as last week's are rare because they involve strangers, Mulvey said.
Even a person who sees the world as a threatening place, who feels persecuted, hopeless or desperate, may think about committing violent acts without ever acting on them, he said.
Drugs and alcohol can push such people over the line by lowering their inhibitions. Many other seemingly innocuous events also could trigger a violent outburst, if they take place at a moment of high susceptibility.
"It's random," Mulvey said. "That's why it's so scary."
When the mental health system works properly, clients receive whatever level of care they require, so that even a person with a tendency for delusional episodes could stay on an even keel. The array of services includes:
In the last fiscal year, about 3,000 residents of Allegheny County received intensive case management from 155 counselors through the Allegheny County Office of Behavioral Health. In that same period, nearly 1,700 people received somewhat less intensive services from 54 resource coordinators.
"No one was turned away to my knowledge, but that could be because they weren't being referred," said Patricia Valentine, deputy director of the Allegheny County of the office.
In addition to the services provided through Valentine's office, untold numbers of people undergo private mental treatment.
Reports of Taylor's mental problems have fueled people's fears and added to the stigma of mental illness, said Harriet Baum, director of the National Alliance for the Mentally Ill of Southwestern Pennsylvania, a self-help and advocacy group.
"We want people to know that mental illness is an illness of the brain, just as heart disease and diabetes are illnesses of the body," Baum said.
"These are treatable conditions, and most people do improve or get better with treatment," she said.
The difficulty is in reaching everyone who can benefit from the assistance, she said.
"We don't know who's not receiving treatment, whether because of the stigma, fear of losing their jobs, or just denial that anything is wrong."
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Hospitalization with psychiatric services to stabilize severe symptoms or keep patients from being a threat to themselves or others.