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Media Sell the Mentally Ill as Violent Criminals. Truth Is, They’re Not.

Columbia University forensic psychiatrist Michael Stone dispels common myths about the intersection of violent acts and mental health disorders.

Michael Stone: The general public, I think, is at the mercy of what they read in the papers. And some of the crimes committed by mentally ill people are very dramatic and unusual. For instance some years ago — it must be maybe more than 20 years ago — there was a fellow Juan Gonzalez on the Staten Island ferry that took a sword of some sort and killed two people. And that of course was very dramatic and it was very much publicized. So it’s things of that sort that the public, not knowing the full statistical picture, are going to get the impression: Oh my god, mentally ill people, you really better steer clear of them if you knew who they were because they’re highly at risk to do something terrible and dramatic and violent.

So it gives the public the worry, the oh my god, the people who are mentally ill are doing these things all the time and the people that do them must be mentally ill because it’s crazy to commit murder. But the fact of the matter is from a standpoint of actual, diagnosable psychosis by a qualified psychiatrist, the number of violent crimes that are committed by mentally ill or psychotic people is relatively small, maybe 5 or 6 or 7 percent. If you’re schizophrenic, the risk of your doing a violent crime is four to six times higher than it would be in the general population. That means that 94 or 96 percent of people who are diagnosed schizophrenic are not committing a violent crime.

However, within the group who are — just to focus for the moment on schizophrenia — who commit a violent crime it depends on a number of other variables. For example if the person is alcoholic, has abused alcohol, then the rate goes up; maybe the risk is like 30 percent or 38 percent risk in the next year they’re going to do something violent. Oftentimes when a violent crime is committed by somebody who seems to be mentally ill, the police have a sense that this guy is not operating with a full deck, as it were. They have their own little expressions about that. They will have the person incarcerated. Maybe in New York City, it could be at Ryker’s or wherever in some local jail. And then have him evaluated by two psychiatrists or two psychologists who are able to do an adequate evaluation of the person’s mental state. If those two people conclude the person is — we don’t say insane. We say not guilty by reason of mental disease or defect — then they will be relegated to a forensic hospital rather than a prison. The exception would be if the crime itself is such high profile that the citizenry would be outraged at the idea of the person being put in this soft berth of the hospital such as Andrea Yates who drowned her five children. She was grossly psychotic. She was hallucinating; she was way out. But the nature of the crime was such that, especially in Texas, that she did get a break. She went to the prison.

Now there was a second trial and there she ended up finally where she should have been in the first place, in a forensic hospital. What the public doesn’t know is a lot of times a person in a forensic hospital was going to be incarcerated there and admittedly a more soft environment than a prison, but for way longer than the person would have been if he had gone through the ordinary prison system. In other words if you rape somebody and it’s a first rape and you’re young you go to prison, we’ll give him 10 years with three off for good behavior. Whereas if a person did a rape of a violent sort and was psychotic at the time and adjudicated as mentally ill and so on, he will go to a forensic setting. And perhaps be kept there for many, many years because it may be a violent record that preceded the major violent episode so that the person’s considered a pretty dangerous person until they’re much older.

And so that the public is actually often in a safer situation with a person in a forensic setting whenever they come up for their two-year evaluations — is the person okay to be released now? The psychiatrist says, "Nope, he’s not ready yet." And I’ve seen serial killers, for example in the forensic setting, who are kept for life. Whereas the same person having killed one or two people when they couldn’t prove that the person had also killed some other people besides would have gotten a comparatively light sentence in a prison, but ended up, justly so, separated from society forever in a forensic hospital. And they’re the ones that often they — let’s say the families are very worried about and the family will get them in the car and say we’re taking you to a picnic, but actually they take them to the emergency room because if the person knew that they were being taken to a psychiatric emergency room, they would not agree to go. And so then they feel railroaded, right arm twisted into going to the psychiatric emergency room or whatever by the family. But the reason that the family felt they had to do that was because maybe the person was behaving peculiarly or even being very disruptive or even maybe doing some assaultive or violent things at home. And they had no choice but to try to get this person into a situation of help even if they had to do it by trickery, kind of benign trickery.

Big Think and the Mental Health Channel are proud to launch Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.


In this video, Columbia University forensic psychiatrist Michael Stone dispels common myths about the intersection of violent acts and mental health disorders. He addresses the question of whether people with schizophrenia are more likely to commit violent crimes and how much danger they present to society at large. The answer? Not as much as you'd imagine, given the sensationalism of mainstream media coverage.

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Predicting PTSD symptoms becomes possible with a new test

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Image source: camillo jimenez/Unsplash
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  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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