In yet another example of sensationalism posing as legitimate journalism, the Associated Press’s Carla K. Johnson penned an article over the weekend calling people with mental illness who live in nursing homes a “threat.” What kind of threat? Well, according to the article, it appears to be the usual one, drawing an unscientific and unsupported link between mental illness and violence:
Over the past several years, nursing homes have become dumping grounds for young and middle-age people with mental illness, according to Associated Press interviews and an analysis of data from all 50 states. And that has proved a prescription for violence, as Jackson’s case and others across the country illustrate.
Younger, stronger residents with schizophrenia, depression or bipolar disorder are living beside frail senior citizens, and sometimes taking their rage out on them.
Wow, that sounds like a serious problem. So let’s look at the new scientific data the AP is reporting on to back up this assertion:
Numbers obtained through the Freedom of Information Act and prepared exclusively for the AP by the Centers for Medicare and Medicaid Services show nearly 125,000 young and middle-aged adults with serious mental illness lived in U.S. nursing homes last year.
That was a 41 percent increase from 2002, when nursing homes housed nearly 89,000 mentally ill people ages 22 to 64. Most states saw increases, with Utah, Nevada, Missouri, Alabama and Texas showing the steepest climbs.
Ah, so this isn’t new scientific evidence per se, just what researchers would call “data fishing” — fishing through datasets looking for interesting (but not necessarily significant) trends.
Since the AP provided none of the actual data (you know, like you might find in an actual research study), you have no way to determine whether a 41 percent increase over 6 years (7 percent annually) is significant or not. Were the previous years worse or better? Has anything changed in mental health benefits since 2002 that explains this increase? You don’t know, because the article offers little information on these points.
So what data points does the AP offer to draw its conclusions? Oh yeah, four stories — 4 data points — out of those 125,000 people who live in nursing homes with a mental illness.
One of the cases describes a woman who had dementia — common in nursing homes — and multiple sclerosis, as well as depression. Hardly a strong example if you want to indict mental illness, as depression is a commonly-used, garden-variety diagnosis in nursing homes.
Another of the four cases describes a 62-year-old (hardly a “younger, stronger resident”) who had no identified mental illness but was described only as “incompetent to stand trial.” Well, that could be for a multitude of reasons, including dementia (again, something very commonly found in nursing home patients).
Even the lead example — a 50-year-old (again, this is a “younger, stronger” person?) — who was not identified with any particular mental illness but was identified with something that is strongly correlated with future violence risk — he had a history of aggression. Yes, this is no surprise. People with a past history of violence or aggressive behavior have a strong likelihood of future violent and aggressive behavior. It is, in fact, the only reliable and strongest predictor for future violence.
While indeed “nursing home dumping” might be a growing problem in the U.S., articles like this continue to do a disservice to the real story by indicting one population rather than the societal conditions that make such an option attractive. If society offered people with mental illness better treatment options than a nursing home, be certain they would take them in an instant.
With perhaps less finger-pointing toward the mentally ill (and especially these sensationalistic, unscientific links to violence), we as a society can find solutions to this kind of problem. Articles like this one by the Associated Press, however, do little to move us toward such solutions.
Read the full article: Mentally ill a threat in nursing homes.
8 comments
I think the association of violence with mental illness is not entirely invalid. That is, people with mental illness diagnoses have often been abused as children, and the fact that they might react to this, especially since their distress is often ignored, with a tendency to want to revenge themselves upon somebody. Most do not act out their anger, often at quite a cost to themselves, but some do.
I believe there are problems on both sides of this argument. While it is true that the vast majority of individuals with mental illness are not violent or dangerous, there is a significant minority of individuals with mental illness who are. As Dr. Grohol accurately points out, it is inaccurate to stereotype all those with mental illness as violent. But it is equally inaccurate to stereotype all people with mental illness as being non-violent. While the article in question is sensationalist, it does raise the very important issue that nursing homes are ill equipped to serve the needs of many individuals with serious mental illness. I think this article highlights the need for improved assessment of individuals in effort to better identify those consumers who may be at higher risk for violence. Most nursing home staff are unfamiliar with and inadequately trained to conduct this type of assessment. I agree with Dr. Grohol when he states that the article unfairly blames the mentally ill rather than the societal factors involved, however I believe we need to recognize the fact that there are some with mental illness who can be extremely dangerous. To paint all individuals with mental illness as dangerous is an unfair and inaccurate stereotype. To deny that some with mental illness are very dangerous is an equally false and inaccurate stereotype. Both of these images are unfair. Those with mental illness are not always the monsters of nightmares but they are also not always the childlike cherubs of fantasy. They are people. Let’s not reduce them to our own projections of who they are. Let’s recognize that them as human beings. And some human beings, including those with mental illness, are extremely dangerous. We need to improve the way we identify risk factors and provide the appropriate treatment and precaution.
It’s easy enough to report on how nursing homes don’t train their staff to adequately handle their increasingly diverse patient population. That’s a very different story, methinks, than what they wrote, however.
Just to be clear, putting our own biases aside, the research is very clear on this point — outside of people who have a history of substance abuse disorder, there is no data to support that a person with mental illness is more likely to commit violence. “Mental illness” is simply an easy answer to people looking for a simple answer to a complex problem, such as the increasingly diverse problems affecting nursing homes. But it is not the correct answer.
Umm… I think there’s a VERY important factor that the article is likely overlooking: There are more people in nursing homes than ever before. Therefore, if they took the total REPORTED cases of violence from six years ago and then took the total number of reported cases from now, and did not account for the increase in nursing home population, I think that would skew the data a hair. Oh yeah, and, as we get more and more paperwork happy, a higher proportion of cases are reported than six years ago, I’m certain.
How does our media get by with this rubbish?
Did you notice the “It’s not known what set him off”? Such a classic stereotyping of mental illness… as though we can be “set off” like dynamite or something, like we’re dangerously volatile and all carrying hatchets in our back pockets to go on killing sprees with.
I was thinking almost exactly the same things about this article when I first read it a few days ago. The autism community is more than a little bit annoyed at it, too; we get dumped in nursing homes just like the mentally ill do (and some of us have mental illnesses on top of autism), so the whole problem of warehousing people who need assistance, instead of maximizing independence, is very well known to us.
Yet another autistic on the street because they’re afraid we’ll hurt somebody… you know, because hand-flapping is SO deadly… *sigh*
Then again, the streets are probably preferable to a nursing home, anyway.
Your statement: “Just to be clear, putting our own biases aside, the research is very clear on this point — outside of people who have a history of substance abuse disorder, there is no data to support that a person with mental illness is more likely to commit violenceâ€, is simply incorrect.
While “mental illness†may not be associated with violence, there certainly are certain symptoms, and even some disorders which are highly linked to violence. For example, the diagnosis of bipolar disorder may not be linked to higher rates of violence. But the symptoms of acute mania, persecutory false beliefs, homicidal ideation, and command verbal hallucinations certainly are. And if you doubt that these symptoms exist in some individuals with mental illness, I would suggest you spend some time in any busy hospital emergency room. It is true that individuals with these symptoms do not constitute the majority of those with mental illness; however it is equally true that these symptoms are not uncommon.
Just as the original article’s author, you are lumping everyone with mental illness into one broad category and stereotyping them all. There are some disorders that are highly correlated with violence, for example, the diagnosis of Intermittent Explosive Disorder requires episodes of serious violence. Not to mention the diagnosis of Antisocial Personality Disorder. Your assertions are not supported by the evidence and your bias is clear.
@Matt… Those symptoms are uncommon when you look at the total population of people who have a mental health problem or a mental illness. And since this article is talking about advocacy and the stigmatizing effects of suggesting that the these two labels (“mental illness” and “violence”) are strongly correlated, it’s appropriate to call into question this broad generalization all too commonly used.
If this were an article about specific disorders or substance abuse, then it would be appropriate to discuss specific associations shown in the research. But it’s not differentiating people based upon what diagnosis they might have — it’s lumping them all together. And if you do that, you have to be fair when doing so, that’s all.
Indeed, I’m all for looking and determining violence risk on an individual basis, exactly as it should be done, using all known risk factors. But the point remains — people with mental illness as a whole have no greater risk of violence than people without.