Violence and Mental Health Opportunities for Prevention and Early Detection: Proceedings of a Workshop (2018) / Chapter Skim
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2 Framing the Paradigm
2 Framing the Paradigm
Pages 5-20
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Insel evoked President Barack Obama's suggested action plan to address gun violence and mental health services, noting that these issues go beyond the 1 This section summarizes information presented by Tom Insel, National Institute of Mental Health.
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. • Violence associated with a diagnosed serious mental illness is more likely to be self-directed than directed at others, even if one in cludes family and friends.
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He questioned this conclusion, as these are relatively rare events; while there is potenialt for this trend, the evidence is not clear. These tragic events capture national attention even though they are a small part of overall risk.
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Additionally, Insel emphasized that schoolbased interventions should not be focused on addressing mental illness, which often has not developed by adolescence, but rather on reframing the issue as improving adolescents' school performance and relationship skills. The majority of those who demonstrate "precursors" do not develop mental illness, he noted.
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"In terms of serious mental illness, we need to remember that recovery is possible when we can get these treatments to people in an effective manner and in a timely m anner," she stated. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
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Mays explained that these definitions are evolving in the context of a changing health care field, in which both services and actors are continuously being defined. ECOLOGICAL FRAMEWORK The ecological framework session included an overview and discussions of risk and protective factors and intervention points related to mental health and violence at the individual, relationship, community, and societal levels.
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However, there are common 3 This section summarizes information presented by Eric Caine, University of Rochester Medical Center.
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A cultural lens highlights multiple perspectives and subjective experiences in a global, comparative context. From her research, which is team based and employs mixed methods including clinical diagnostic criteria, statistical analysis, and ethnography, 4 This section summarizes information presented by Janis Jenkins, University of California, San Diego.
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• Symptom content, form, and constellation • Clinical diagnostic process • Illness experience: identification, explanatory model, and meaning • Kin emotional response and bonds and attachment • Community social support stigma • Service use and preferred treatment modalities • Resources for resilience and recovery • Course and outcome In terms of symptoms, Jenkins advised further attention to not only whether the symptom is present, but how it presents, as well as how symptoms aggregate. Furthermore, culture influences what is considered typical and atypical, how explanatory models are developed, how those with mental illness are viewed, how the illness course proceeds, and what outcomes develop.
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They spoke of the failure of detecting mental illness related to violence before the occurrence of such violence, particularly suicide. Caine remarked that instead of focusing on individual risk, going "upstream" at the population level means examining life circumstances in the community and the family.
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Rosenberg addressed definitional issues around the concept of risk, including perceived risk, measured risk, absolute risk versus relative risk, and population-attributable risk. The intersection of mental health and violence is highly dependent on how these terms are defined.
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For those with mental illness, the relative risk of violence was 2.0, serious mental illness was 3.5, and substance use disorder was 3.3; for serious mental illness plus substance use disorder, it was 11.5 (NIAAA, 2005)
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He distinguished between two forms of interpersonal violence: reactive violence is frustration based or threat based, while instrumental violence is used to achieve a goal. Several mental health conditions increase the risk of reactive aggression, such as anxiety, borderline personality disorder, childhood bipolar disorder, depression, intermittent explosive disorder, and psychopathy.
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In fact, this is the case in brain scans of people with PTSD and other disorders known to increase risk of reactive aggression. Trauma and neglect also increase the responsiveness of this threat circuitry, and problems of emotional regulation block the ability to reduce the responsiveness.
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And finally, he mentioned the role of alcohol, which in healthy individuals reduces response to distress of others and affects reward–punishment decision making. In the discussion following the presentation, Blair addressed a question regarding how suicide plays out in these neurocognitive systems by noting that it is difficult to determine because the brain architecture explored does not generate self-harm behavior in mammalian species.
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2001. Strengthening mental health promotion.
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