Mental Illness and Violent Death : Major Issues for Public Health
In an accompanying editorial, Thomas B. Cole, M.D., M.P.H., and Richard M. Glass, M.D., of JAMA, Chicago, comment on the studies in this week's JAMA on suicide and violence.
"Identifying persons at risk of violence to themselves or others and offering or compelling them to receive mental health treatment services is warranted. Barriers to delivery of these services may be financial, such as lack of access to health care; structural, such as the lack of mental heath programs and practitioners; or personal, such as concerns about confidentiality or discrimination. Another barrier is scientific - lack of randomized controlled trials of therapeutic interventions for suicide and interpersonal violence prevention to guide clinical and systems management."
"Other strategies for violence prevention address the lethality of weapons or social, pharmacological, and other situational factors that may lower the threshold for violent ideation to progress to violent action. Although these factors are late in the causal pathway from mental illness to violence, they are no less important for the prevention of violent death. A severely anxious, depressed, impulsive, or hopeless person whose violent actions are interrupted before he or she harms himself or herself or someone else would be considered a good outcome from the perspective of violence prevention. But without effective psychiatric treatment, such a person will still be in distress and is likely to remain at risk for violence. From this public health perspective, society should devote adequate resources to developing and evaluating psychiatric treatments and lowering barriers to their delivery," they conclude.