Recent reports from the BBC highlight the complexities of helping people with psychotic illnesses – specifically schizophrenia, live symptom free and positive lives. 

The first story “NHS ‘failed’ over cannibal killer” presents an all too common media response to the extremely rare and thus somehow newsworthy bizarre homicide involving a person suffering from a mental disorder and the problems encountered in better understanding and assisting such individuals from people working within the mental health system.  While better training and more careful assessment procedures are in and of themselves important, it is hard to see what such news stories accomplish – except to perpetuate the stigma against people living with a mental illness and those who treat them.

The other story “Embracing the dark voices within” describes the approach (one that is unencumbered by evidence) of a person described as psychologist Rufus May.  What I can glean from this story is that the so called treatment involves getting in touch with your psychosis (voices) in the absence of medication.  Oh dear – here we go again.  This is nothing new and we have seen the chaos and destruction of lives and families that such idiotic ideologies have created in the past.  Those of us old enough to remember the psychoanalytic schools of living through the psychosis or the negative impacts of community circles or the strange world views expressed by the popular “philosopher” R.D. Laing in his books: Bird of Paradise and Politics of Experience or the sad “treatment” described in the novel “I Never Promised You A Rose Garden” shudder when we see history repeating itself.

Schizophrenia is a highly complex and disabling brain disorder often striking in the teen years.  We have good evidence on how to provide treatment – evidence based on solid science and many years of improvements and the integration of biological, psychological, social, vocational and civic engagement strategies to promote recovery.  Regressing into the darkness of the uninformed past is not news – just as the rare and bizarre homicide is not news.  Neither serves the better understanding of mental illness and its optimal treatment. 

I would really like to see some stories about how young people have coped with and overcome their disability.  I would really like to see some stories about how families have struggled with the adversities wrought by the illness – and have come out on top.  I would really like to see some stories about the human relationship between care providers and those living with the illness – the relationships that have gone on for years and have provided the basis for recovery and success.  Now, who can we find to write those stories for the BBC?

-Stan

The case of Vince Li, the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness :”Canada judge: Vince Li not responsible for bus beheading due to mental illness” (Associated Press), “Canada bus killer found mentally ill” (The West Australian), “Judge rules bus beheading suspect mentally ill” (CNN.com), “Crazy bus cannibal sent to mental institution” (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to “demonize” Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media’s tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

From Reuters:

According to Chris Summerville, the Chief Executive Officer of the Schizophrenia Society of Canada, the likelihood of violence by people with mental illness is exceptionally low. In fact, people living with mental illness are more often the victims of violence. “Fortunately, studies show that when people who were or would have been dangerous receive psychiatric treatment they are no more dangerous than people without a diagnosis. But they have to receive the treatment,” says Dr. John Gray, a board member of the British Columbia Schizophrenia Society.

Some evidence suggests that certain medications might rarely be associated with aggression, but this doesn’t mean there is a link between psychiatric medications and violent behaviour. In fact, the drug that is most often associated with aggressive behaviour is alcohol! Many medications used to treat mental disorders are also helpful in treating violent behaviour. It is important to remember that the best known predictor for future violent behaviour is past violent or criminal behaviour, not mental illness.

While a tragedy of this scale is awful, it can lead to constructive discussions about the need for improved care and a national mental health strategy.

This tragic event reinforces the urgent need for a national mental health strategy. Despite the significant health, economic and social costs of mental illness, Canada is the only G8 nation without a national strategy on mental illness. Summerville who is also a board member of the Mental Health Commission of Canada, says, “In many areas in Canada, there is a lack of psychiatric beds as well as lengthy wait times to access appropriate mental health care.” He adds, “If there were not a comprehensive hospital or community services for people with cancer, heart problems or other medical conditions, we as a society would be outraged. Stigma and the lack of social and political will have resulted in Canada’s failed mental health system.”

Canada has recently made some important strides in addressing mental health and mental illness. The establishment of the Mental Health Commission of Canada is indeed a vital step. But unfortunately it may be some time before the national discourse and media coverage of people with mental illness catches up, and we stop stigmatizing and sensationalizing people living with mental illness.

~ D. Venn & Dr. Stan Kutcher