Are the mentally ill a danger to society?

The recent case of a psychiatric patient who attacked two people in the waiting room of Kalafong Hospital in Pretoria once again raises the question: are people with mental illness a danger to society?

Prof Michael Simpson, Health24's CyberShrink, believes that sensationalist media reporting perpetuates a stereotype of psychiatric patients.

"When someone does something cruel, people often think: you must be nuts to be able to do something like that. The fact is that most psychiatric patients are not dangerous and most dangerous people have no history of psychiatric illness. Several studies have shown that with all psychiatric conditions, the risk for aggression is lower than the risk posed by your average neighbour," says Prof Simpson.

"The majority of people who commit crimes are not ill, they may be evil, wicked and horrible people who don't care about others' feelings and who don't regard others' pain as real. There have been countless evil people in history; just think of all the heinous deeds of many political leaders who didn't have any diagnosable mental illness."

People are generally afraid of others they regard as being different or foreign to them. There is a parallel here with the "stranger danger" concept that people teach kids in an attempt to protect them from sexual abuse. Warning kids that only strangers are dangerous is misleading, given that in most cases of child abuse, kids are abused by people familiar to them – very often their own family members.

"People often believe: lock up everyone with a mental illness because then we will be safer. The joke is that the mentally ill will then be safer because they are protected from those with a greater capacity to kill and harm others," says Simpson.

Physical illness
Simpson raises another interesting point: the fact that the patient was in the waiting room of a general hospital and not a psychiatric hospital suggests a strong possibility that he was suffering from a physical illness.

"There are several physical illnesses that can lead to aggression. In fact, a physical illness can make one far more dangerous than a psychiatric illness. Take high fever and delirium, for example, or someone with diabetes who has become hypoglycaemic, or who has a brain tumour."

According to Simpson, many paramedics and medical personnel are not adequately trained to assess the potential for violence in a patient and don't know how to handle it. The fact that someone is a psychiatric patient shouldn't raise alarm bells. But a history of violence should – this is by far the best predictor of future violence.

Stigma prevents people from seeking help
The sad outcome of the perpetuation of this myth – that psychiatric patients are dangerous – is that the mentally ill are often discouraged from seeking help. If a person is diagnosed with a mental illness, he or she immediately gets labelled by some as posing a threat to society.

"When the media wants a terrifyingly dangerous, malicious, random killer or attacker, they are either too lazy, or too unskilled, or too pressed for time to provide any reasonable explanation for why anyone would do such dramatic and awful things. They too often suggest that such perpetrators are somehow psychiatrically ill. And so it is with thoughts of Freddy Kruger and Hannibal Lector that too many people think of someone with a psychiatric illness, who are in fact more likely to be a danger to themselves than to others." - Health24

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