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January 29, 2015
by Lisa La Rose, M.A., L.P.C.

Violence, Stigma, and Mental Illness: Understanding the Real Connections

January 29, 2015 07:55 by Lisa La Rose, M.A., L.P.C.  [About the Author]

It is an unfortunate fact that many people associate mental illness, and the associated symptoms, with violence and aggression.  With recent school shootings and other violence being reported too often on the news, many people are left wondering if the perpetrators of these horrors are mentally ill.  In some cases, we learn that the perpetrators have been diagnosed at some point in their life with a mental illness.  For example, it was widely reported that Adam Lanza, the 20 year old shooter at Sandy Hood Elementary School in Connecticut, had been diagnosed with Asperger’s (Solomon, 2014).  But is mental illness the only explanation for Lanza’s extreme violence?   Cases like this can further solidify the belief that people with mental illness are a danger to society.  However, it’s important that we look at the facts to avoid further stigmatizing people who live with mental illness every day.

Is there a link between mental illness and violence?

According to Dr. Eric Elbogen, assistant professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine, “mental illness alone does not increase the risk of violence” (Doheny, 2009).  This indicates that other factors are at play when a person behaves in violent ways.  These other factors include things like substance abuse, history of violent behavior, age, gender, and stressors like unemployment or divorce.  The presence of mental illness, alone, is not enough to increase the risk of violence, but the presence of alcohol or drug abuse with mental illness can increase the risk.  The risk increases further with the combination of mental illness, substance abuse, and a history of violence.  In fact, the risk for violence goes up 10 times for those with a mental illness, substance use problem, and a history of violence, compared to those who only have a mental illness (Doheny, 2009).

In a 2009 study with 35,000 participants, Dr. Elbogen found that of those who only had a severe mental illness, 2.4% had been violent. But when he looked at those with major depression and substance abuse or dependence, 6.47% had been violent.  Similarly, 5.15% of study participants diagnosed with schizophrenia had been violent, but when the participants with schizophrenia also had substance use problems, their reports of violent behavior went up to 12.66%. According to Elbogen, one study reports that 75% of people believe people with mental illness are dangerous, even though mental illness is not one of the leading causes of violence in our society. Simply having a mental illness does not predict violent behavior, and people with mental illness are no more likely to commit a violent act than anyone in the general population. (Doheny, 2009).                 

Additional studies have evaluated any connections between gun violence, specifically, and mental illness.  It is too easy to look at offenders like the Aurora Theater shooter, James Holmes, and make a connection between a claimed mental illness and an act of senseless violence.  While mass murderers with mental illness do get a great deal of media attention, they are not typical of those who commit violent crimes.  These studies have found that mental illness is not the main cause of societal violence; instead we should focus on people who have real behavioral risk factors for violence (Gun Violence and Mental Illness, 2014)  There are other factors that have been shown to be stronger predictors of violence than mental illness. These factors include things like:

  • Being subject to a domestic violence restraining order

  • Having been convicted of a violent misdemeanor offense

  • Having two or more Driving Under the Influence (DUI) convictions in a five year period

  • Having two or more controlled-substance convictions in five years (Gun Violence, 2014).

Again, the research evidence does not support the belief that people with a mental illness are more dangerous.  In fact, what the research does tell us is that people with mental illness are far more likely to harm themselves, or become a victim of a violent crime.  

Dr. Jeffery W. Swanson, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine, found that an estimated 3.5 million people with serious mental illnesses are going without treatment every year.  He also asserts that, “even if schizophrenia, bipolar disorder and depression were cured, our society's problem of violence would diminish by only about 4 percent. A person with serious mental illness is far more likely to be a victim of violent crime than a perpetrator” (Gun Violence, 2014).

Stigma and the Myth of Violence

Understanding the facts about the risk of violence and mental illness is essential to defeat stigma and overcome barriers to treatment for those living with mental illness and their families.  Stigma impacts people with mental illness by lowering their self-esteem, interfering with their ability to socialize and find safe housing, and negatively impacting their ability to find employment.  A number of studies have also shown that a major cause of stigma is the perception that some individuals with mental illnesses are dangerous (What is the Main Cause, 2014).   

While education is a very valuable tool in reducing stigma, more needs to be done.  Even with concerted anti-stigma campaigns, stigma still seems to be on the rise, with one study reporting that stigma increased significantly between 1996 and 2006.  Compared with study respondents in 1996, respondents in 2006 were more unwilling to have someone with schizophrenia as a neighbor. This finding was also reflected in the 1999 Surgeon General’s report on mental health. “Stigma in some ways intensified over the past 40 years even though understanding improved” Additionally, a 2008 Harris poll reported that a majority of the public believes that violent behavior is a symptom of schizophrenia, and “roughly one in four Americans say they would feel uncomfortable around adults who have been treated for schizophrenia” (What is the Main Cause, 2014).

How can stigma about violence be reduced?

We know that violent acts by people with mental illness are a primary cause of stigma, and that this stigma won’t disappear, entirely, until these events stop happening.  There are a number of factors that contribute, more significantly, to the risk of violence, and these factors mist also be addressed. Accessible and effective treatment is one way of reducing violent acts by people with mental illness. Since violent behavior by individuals with untreated severe mental illness is the main cause of stigma, it is unlikely that stigma will be decreased until the violent episodes are decreased.

Many others have come to this same conclusion, over the years.   For example, in 2012 former APA President, Steven Sharfstein, noted that negative attitudes toward persons with serious mental illness are unlikely to decline “as long as there are untreated, delusional, disheveled, threatening homeless individuals on our streets and in high-profile media examples of violence (What is the Main Cause, 2014).  Even one episode of violent behavior by a person with mental illness fuels already existing stigma, despite our knowledge about the very weak link between mental illness and violence.  So, what else can we do to reduce the stigma faced by people with mental illness?

  • Know the facts.  Become educated about mental health problem, and the issues faced by people with mental illness

  • Be aware of your attitudes and behavior.  We’ve all grown up with prejudices and judgmental thinking. See people as unique human beings, not as labels or stereotypes. See the person beyond their mental illness; they have many other personal attributes that do not disappear just because they also have a mental illness.

  • Choose your words carefully:  The way we speak can affect the way other people think and speak. Don't use hurtful or derogatory language. 

  • Educate others: Find opportunities to pass on facts and positive attitudes about people with mental health problems. Challenge myths and stereotypes.

  • Focus on the positive: People with mental health and substance use problems make valuable contributions to society. Their health problems are just one part of who they are.

  • Support people:  Treat people who have mental health problems with dignity and respect. Think about how you’d like others to act toward you if you were in the same situation

  • Include everyone:   It is against the law for employers and people who provide services to discriminate against people with mental health and substance use problems (Seven Important Things, 2014).

Violence is a main cause of stigma toward people with mental illness, but lack of knowledge and education are also part of the problem.  People with mental illness are no more likely to commit violent acts than anyone else, but when mental illness is present with substance abuse and a history of violence, that risk does increase. As a society, we must better understand and effectively address all causes of violence.


Doheny, K. (2009). Mental illness and violence: A link? Retrieved August 19, 2014, from

 Gun violence and mental illness: Study addresses perception vs. reality. (2014, June 14). Retrieved August 19, 2014, from

 Seven Important things we can do to reduce Stigma and Discrimination. (2014). Retrieved August 19, 2014, from

 Solomon, A. (2014, March 17). The Reckoning - The New Yorker. Retrieved August 19, 2014, from

 What is the main cause of stigma against individuals with serious mental illness? (2014, March). Retrieved August 18, 2014, from

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