On February 26–27, 2014, the National Academies of Sciences, Engineering, and Medicine’s Forum on Global Violence Prevention convened a workshop titled Mental Health and Violence: Opportunities for Prevention and Early Intervention. The workshop brought together advocates and experts in public health and mental health, anthropology, biomedical science, criminal justice, global health and development, and neuroscience to examine experience, evidence, and practice at the intersection of mental health and violence. Participants explored how violence impacts mental health and how mental health influences violence and discussed approaches to improve research and practice in both domains.
This workshop was the seventh in a series of workshops held by the Forum on Global Violence Prevention, which works to promote research on both protective and risk factors, to encourage evidence-based prevention efforts, and to facilitate dialogue and exchange by bringing together experts from all areas of violence prevention. The forum is tasked as follows:
1 The planning committee’s role was limited to planning the workshop. The Proceedings of a Workshop was prepared by the rapporteur as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
- Provides an ongoing, regular, evidence-based, impartial setting for the multidisciplinary exchange of information and ideas concerning violence prevention
- Illuminates policy, research, and practice priorities worthy of further study or investment
- Gathers information on the scientific basis and public health needs pertinent to global violence prevention
Past workshops have explored the evidentiary basis of violence prevention, the contagion of violence, the social and economic costs of violence, and violence against women and children, among other topics.
In her introductory comments, planning committee co-chair Peggy Murray of the National Institute on Alcohol Abuse and Alcoholism explained that this workshop on mental health and violence prevention emerged from discussions held during previous workshops, as well as current events and media reports. She noted that what is known about mental health and violence prevention is complicated, and what is not known is vast. Law enforcement officials, in particular, are burdened by the number of people with mental illness they encounter and are not well equipped to deal with these numbers outside of traditional corrective means. Planning committee co-chair Mark Rosenberg of The Task Force for Global Health further explained that the intersection of mental health and violence is confusing. Is the relationship unidirectional, and in which way, or is it bidirectional? The workshop planning committee sought to shed light on this issue to gain a clearer picture of this interaction.
Because the relationship between mental health and violence is complex, complicated, and of interest to numerous stakeholders, the planning committee acknowledged that it was not feasible to conduct an exhaustive review in a 2-day workshop (see Box 1-1 for the Statement of Task). Thus, the committee identified the following topics as important to address:
- A description of mental health function as a continuum, from optimal to dysfunctional, with problems ranging from minor to serious distress to antisocial behavior to severe mental illness
- Perpetration of violence, victims of violence, and exposure to violence
- Interpersonal, self-directed, and collective violence
- Neurobiology of violent behavior
- Multiple ecological levels to be considered
- A life-course/developmental perspective
- Means of violence perpetration, including access to weapons
- Identification of the multiple sectors that must be involved, as well as their intersection
This Proceedings of a Workshop provides a summary account of the workshop presentations and the expert papers submitted by workshop speakers. This proceedings comprises six chapters, including this introduction. Chapter 2, Framing the Paradigm, presents opening remarks from the keynote speaker, Thomas Insel; operational definitions from Vickie Mays; an ecological framework approach from Eric Caine and Janis Jenkins; an exploration of the intersection of mental illness and violence from Mark Rosenberg (speaking on behalf of Paul Applebaum); and the neurobiology of violent behavior from Jim Blair. Chapter 3, At the Intersection of Mental Health and Violence, details lived experiences and perspectives on mental health and violence, as presented by Daniel Fisher, Elyn Saks, Harvey Rosenthal, and Robert Bernstein. The chapter also outlines information on assessing and detecting mental health dysfunction and risk of violence from the presentations of Seena Fazel, Dustin Pardini, and Dieter Wolke.
Chapter 4, Means and Modifiers, includes presentations on restricting the means of violence from Daniel Webster, Michael Phillips, and Mike Luo; and on alcohol and alcohol use disorders from Klaus Miczek, Kenneth Leonard, Toben Nelson, and Ronaldo Laranjeira. Chapter 5, Prevention, Intervention, and Treatment, covers mental health services and violence from Colleen Barry, Sharon Stephan, and Dévora Kestel, and the interface with the justice community from Madelon Baronski, Sheldon Greenberg, Ray Kotwicki, David Wexler, and Patrick Fox. The final chapter, Assembling the Pieces and Integrating Elements, includes a presentation on an evaluation of interventions by Hendricks Brown, and a synthesis of the summary panel and subsequent discussion on the way forward.