Recent mass shootings have inevitably led to news reports of the suspected shooters’ mental health, but psychological research shows there is no clear link between mental illness and violence. In this episode, clinical and forensic psychologist Joel Dvoskin, PhD, talks about the misconceptions surrounding mental illness and violent behavior and how basic prevention efforts could help stop future violent events.

About the expert: Joel Dvoskin, PhD

Joel Dvoskin, PhDJoel Dvoskin, PhD, has been a licensed clinical psychologist for over 30 years. He earned his PhD in clinical psychology from the University of Arizona in 1981 and he holds a diploma from the American Board of Professional Psychology in Forensic Science. He is an expert in the field of forensic psychology and has been asked to contribute to a wide variety of projects and boards throughout academia and public service. Most notably, he has served on the White House Panel on the Future of African-American Males, the American Bar Association Task Force on Capital Punishment and Mental Disability and the Research Advisory Board for the United States Secret Service.

Dvoskin served as president of APA Div. 18 (Psychologists in Public Service) and Div. 41 (American Psychology – Law Society). He has served as the acting commissioner of the New York State Office of Mental Health and is currently the chair of the Nevada Governor’s Advisory Council on Behavioral Health and Wellness . Dvoskin has served as a monitor of federal court settlements overseeing prisons, jails and psychiatric hospitals.

In addition to his career as a consultant, Dvoskin is an assistant professor of psychiatry at the University of Arizona College of Medicine. His many honors include the Peggy Richardson Award from the National Coalition for the Mentally Ill in the Criminal Justice System, the Amicus Award from the American Academy of Psychiatry and the Law, the Special Achievement Award from APA Div. 18 and the Distinguished Contribution to the Sciences of Psychology Award from the Arizona Psychological Association.

Transcript

Audrey Hamilton : The state of a perpetrator’s mental health is often the focus of news reports in the aftermath of mass shootings and other acts of violence. Legislators and the public want to be able to predict if and when a person will become violent. In this episode, forensic psychologist Joel Dvoskin talks about why the stigma surrounding mental health is to blame and also how psychologists can help prevent more violence if they are just given the opportunity. I’m Audrey Hamilton and this is “Speaking of Psychology.”

Joel Dvoskin teaches in the department of psychiatry at the University of Arizona. He is chairman of the Governor’s Advisory Council on Behavioral Health for the state of Nevada. He’s also a clinical and forensic psychologist. He served as an expert witness in several state and federal courts throughout the U.S. and he specializes in assessing a person’s risk of violence to self and others, as well as workplace violence prevention. Welcome, Dr. Dvoskin.

Joel Dvoskin: Thank you very much for having me.

Audrey Hamilton :  There have been several high profile shootings in the news where the suspect has been described as having some sort of mental disorder, either officially or anecdotally. What sort of message is this sending to the general public about the association between mental illness and violence? Is there a link?

Joel Dvoskin: Well, there’s a lot of messages that it sends and some of them are very inaccurate and, in fact, counterproductive and harmful. The short version is that while people with serious mental illness are slightly more likely to commit acts of violence than people without mental illness, the risk that it creates is pretty small compared to other known risk factors. For example, current substance abuse. It’s also true that a lot of the people that you read about, these anecdotes are played up by the media and people overgeneralize from these very dramatic examples. So, when you see somebody do something horrible you think it happens more often than it actually does.

So the facts are pretty clear that, first of all, mass homicide accounts for a very tiny percentage of all the gun deaths in the United States, like one or two percent. And even homicide is less of a problem in terms of gun deaths than suicide.

Another example is where the electronic media focus on long guns, like Bushmasters and assault weapons. They account for a very small percentage of gun violence in the United States. The vast majority of gun violence has to do with hand guns. So, there’s a lot of misinformation and the press only cares about selling adver … – not the press but the electronic media – mainly cable news mainly care about selling air time so they put on the things that are most dramatic and that causes people to overgeneralize. The results of that is that it creates additional stigma about mental illness and actually discourages people from getting treatment. So, it’s bad for a lot of reasons.

Audrey Hamilton :  What role does mental health stigma play in the debate over gun violence and gun policy, specifically stigma?

Joel Dvoskin: Well again, the politicians have an unfortunate tendency to react to what is most publicized and also to react to anecdotes as opposed to solid research and we don’t know enough to really guide public policy, so stigma, which is sort of a collection of myths and stereotypes, tends to guide public policy far too much and, as I said, much of it is incorrect.

So, we end up with policies that people tout as saying “we did something” but, in fact, it’s either not helpful or in some cases counterproductive. And we’d be far better off as a country if instead of relying on stigma people were encouraging really good research about how to reduce gun violence rather than just react to these extreme cases and the stigma and myths of stereotypes.

Audrey Hamilton An example of this, you know, some legislators have been pressing for laws that prevent the sale of firearms to anyone who has ever been diagnosed with a mental illness. Should mental health be taken to account when deciding who can own a firearm?

Joel Dvoskin: If a person has schizophrenia, the likelihood that they will kill a stranger has been estimated, according to research, at one in 144,000. So, it’s popular for politicians to say “Oh, I did something.” The myth is you have to be “crazy” to do something like this. So retrospectively, you look at people and you say, wow, this obviously – that guy should have been branded. But the truth is that most of the people, even of these anecdotes, were people who were very early on in their illness, who had not been identified as seriously mentally ill, who wouldn’t have been on the list anyway. There’s a couple of exceptions for that. So for the most part, it’s stuff that’s easy to sell as to say “I did something really important.” But alcohol accounts for a great deal more violence than mental illness does.

Audrey Hamilton :  As a forensic psychologist who assesses people who might be a risk to themselves or to others, what challenges do you face in determining who will become dangerous?

Joel Dvoskin: There’s a whole bunch of research about assessing the risk of dangerousness that looks at the traits of a person. But, we know that all human behavior is an interaction between a human being and the circumstances or situations in which they find themselves. And it’s very difficult to predict the situations that a person is going to be in the future. We think that a better strategy is when you become aware of a person who is either uttering or posing threats, is then to look at the person in the context of the situation they’re in and make recommendations to intervene and change that situation.

Steve Hart, one of my colleagues and friends, calls these “risk scenarios” – is under what circumstances would this person be likely to harm somebody. That’s much more helpful than saying “this guy’s a high risk person” based on these sort of all or nothing determinations, but there are a number of different methods of risk assessment and many of them are really good. Some are actuarial, which help you look at the kind of overall risk that a person might present. But it won’t tell you under what circumstances they will or won’t. So, even if you knew that somebody had a 50 percent chance – was in a group of people with a 50 percent chance of being violent, you don’t know if they’re in the 50 that will or the 50 that won’t, and it may depend on the situations in which they find themselves.

When you do risk assessment, risk assessment by itself isn’t very important. What matters is the steps that are taken as a result. So that could be treatment; it could be intervening in the situations, it could be skill teaching for people. Their goal is to no longer call people by their names, it’s to actually prevent violence.

Audrey Hamilton :  What ways can mental health services be more effective in assessing and treating people who could present a danger to themselves or others?

Joel Dvoskin: Well, in my opinion, the most important role of the public mental health system in preventing violence is not related to the treatment of serious mental illness, although that’s very important for clinical reasons. But, where we really want to see the public mental health system better funded and better capable of intervening is in crisis response. So, when somebody feels depressed, enraged, insignificant, they have access to a firearm, maybe they’re drinking too much that night, maybe they just got fired and so on – it’s like this perfect storm of despair. It would be very important for our system to be able to give that person really competent suicide prevention services in this crisis to give them an alternative to ending their life as a way of ending their psychological pain.

And that’s something – and it’s not a criticism of the people who are doing this work – there are some wonderful first responders both in mental health and paramedics and police, but if you get good at this you can’t keep doing it because the pay’s not very good. If you want to raise a family, people quit those jobs and go onto other things so they can make a better living. So, we need more money so we can have more timely, more competent crisis response services by the public mental health, as well as other first responder systems. And that would, I think, every time somebody commits a mass homicide, they’re ending their life. They’re either going to commit suicide or they’re going to get the police to shoot them or they’re going to go to prison or hospital for the rest of their life. They’ve given up. Their life is over. And we know how to prevent suicide. We just don’t do it. We know a ton about suicide prevention and yet the suicide rates in the United States haven’t gone down because we haven’t made a good societal investment in suicide prevention and crisis responding. And that I feel is very important and would make a very big difference.

I also would say that we need a lot more information and data and Congress has, to an unfortunate extent, stifled research on preventing gun violence. So the National Violent Death Reporting System is only exists in 16 states. That should be nationwide. CDC, the Centers for Disease Control, is discouraged from doing research on gun violence and it’s not about the Second Amendment. There’s going to be guns in the streets of America for as long as I’m alive. But that doesn’t mean that we can’t learn more about how to prevent violence – violent use of these guns and inappropriate use of these guns through a variety of mechanisms including public information, training, safety training. There’s a lot of different things. And we just don’t know which things work because there hasn’t been enough research done.

Audrey Hamilton :  OK, Dr. Dvoskin, thank you so much for taking the time to speak with us.

Joel Dvoskin: I appreciate you having me. Thank you.

Audrey Hamilton :  For more information on Dvoskin’s research and to hear more episodes, go to our websitewaffftcsvqrbfwytdazvcxzd . With the American Psychological Association’s “Speaking of Psychology,” I’m Audrey Hamilton.

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