Violence and Mental Illness

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The tragedy in Newtown, Connecticut is raising the debate over a variety of issues, including gun control & school safety. It’s also increasing awareness about mental illness. Phoenix psychiatrist Dr. Michael Yasinski discusses what is known and what we should know about violence and mental illnesses.

Ted Simons: The tragedy in Newtown, Connecticut, is raising the debate over a variety of issues, including gun control and school safety. It's also increased awareness of mental illnesses and its association with violent incidents. Here to tell us what is known and what we should know about mental illness and violence is Scottsdale psychiatrist Dr. Michael Yasinski. Good to have you here.
Dr. Michael Yasinski: Nice to be here.
Ted Simons: Define if you could for us "Dangerously mentally ill."
Dr. Michael Yasinski: State to state varies a little bit but I will stick to the Arizona statute here. Really it comes down to about three things. It means you are imminently at risk to kill yourself, imminently at risk to kill somebody else, or if you are taking such poor care of yourself that you can't meet your basic needs, like shelter, feeding, those three things kind of fall into the severe mentally ill that you could be against your will given some type of medical treatment.
Ted Simons: How does that delineate between what you are talking about and then the dangerously mentally ill who may very well be able to take care of themselves and may not, may be able to function in a variety of other ways but who have this other thing going on?
Dr. Michael Yasinski: Right. So part of the problem, and I see this all the time with my patients, is I see people not doing well at all. A lot of people have something called psychoses, which is simply being out of touch with reality in diseases like schizophrenia or bipolar. They lose their insight or the ability to think rationally but yet they are not necessarily violent at the moment but you let them go live in their house, they are not able to be forced into any kind of treatment and as 9 days go on, that process gets worse and they become very violent. And by then it's too late to act.
Ted Simons: What are some of the warning signs then where you can maybe take, see someone who has unfortunately progressing from that A to that B?
Dr. Michael Yasinski: I think if you can especially family and friends, if they can keep an eye on the person, that's always a difficult thing. Because one of the big things is these people start to isolate. And when you are isolating it's very hard for a family and friends to even see what's going on. I always say, if you notice anybody, especially with an underlying mental illness they are isolating, I think you need to have, whether it's your friends, check them out. I actually encourage people to call the police. They will go do a well check at their home and knock on their door. And you can't get in any trouble for doing that. The police will show up. They don't mind. At the very least they can put their eyes in the place and make sure nothing too crazy is going on in there.
Ted Simons: Has the definition of dangerously mentally ill person, has that definition changed over the years?
Dr. Michael Yasinski: I think it's -- it's subtly different from state to state. But in general it's pretty much the same criteria of the harm to self, harm to others is really the main two components of that.
Ted Simons: And if someone vocalizes, maybe writes this down, their intent to do these sorts, is that dangerous enough to have some sort of interaction occur?
Dr. Michael Yasinski: Yeah. It has to be specific. Almost to the point where someone is writing a plan down to hurt you, for example. Just writing down things like I like to hurt people, often aren't enough especially in Arizona where we have pretty strong rights for the people. If it's too generic that's often not enough. If it's simply talking about how I want to die but I don't have any specific suicide plans, that's often not enough. So as a psychiatrist, I end up trying to take these people in to get hospitalized, the center says, no, there's not enough evidence. So they go back on the streets. And there's nothing left to do for them until they get worse and then finally meet the criteria that they need to get worse but by then it's too late.
Ted Simons: When they get back on the streets, and you mentioned the rights of the mentally ill you are talking full rights here. You are talking second amendment rights here.
Dr. Michael Yasinski: They have full rights. Even more rights in terms of, you know, we are the ones that have to prove beyond a reasonable doubt just to show there's some risk of these people doing something. I mean, we just have to present so much evidence, and they just have to present basically the fact they are just living at home doing fine, not doing any of this and that's enough to let them go.
Ted Simons: Is there -- do you sense or see a push to change this, especially in light of recent incidents?
Dr. Michael Yasinski: I know Arizona we have some attorneys working very hard. I know chick Arnoldson, an attorney in town working on these things. In my view as a practicing psychiatrist there has to be more lenience who can we get into involuntary treatment like when a professional opinion like myself, we can see that just because there's not X, Y, and Z there, there's other stems that are just as concerning that maybe don't meet the criteria but concerning enough that I think they have to be evaluated in a hospital. So a little less stringent and rigid needs to happen, in my view.
Ted Simons: Once they are evaluated, once they are available for treatment, if you will, how do you treat those? Again, not just mentally ill but dangerously mentally ill?
Dr. Michael Yasinski: Yes. It's the same, you know, it's even hard once they are in treatment to keep them there. Because if they stop saying that they are violent or they stop saying they want to kill themselves two days into the hospital stay, then, that's a ready path to get out of that hospital stay very quickly. It almost has to be like they are consistently saying those things to get any kind of forcible treatment. So the hope that is they are recognizing some danger and you are able to medicate them and that medication gets them better enough to the point where some of their underlying mental illness starts to ease away and they come back to reality and they start thinking more rationally, and they are on their way to getting better.
Ted Simons: When you hear about these incidents in Tucson, in Newtown, Connecticut, in Colorado, the many incidents it seems like in Colorado, when you hear about these people and their lives leading up to these incidents, any surprises there at all?
Dr. Michael Yasinski: I think a lot of these people have the same background stories in terms of typical kid in school, typical kid tends to isolate, typical kid may be involved in computer games in the beginning. They kind of have that same few features. And, you know, it ends up being pretty consistent across the whole board, if you look at that type of person doing these kind of things. Because even though mental health patients don't have a hugely higher risk of violence, it still is there. It's still two to three times more violent than the regular population when you are looking at schizophrenia, bipolar, major depression, alcoholism. So it's a significant amount, even though most aren't violent, know, it is a significant percentage compared to the rest of the population.
Ted Simons: Indeed. Most kids who are isolated and playing video games don't wind up doing these sorts of things. It really is the balance there is very difficult to find.
Dr. Michael Yasinski: Right. Exactly. The other thing is, you have to be careful about part of the labeling or part of this kind of talk of how can we label people violent and how can we get them treatment and what's even force treatment, all of that works for kind of the current system of safety. But then you look back and think, well, what is the underlying problem that needs to be fixed in mental health? It really is stigma. Right? So the stigma of psychiatry is what makes people not want to even get help. If you are further stigmatizing them by saying evening is a criminal who is a psychiatric patient, you have the people that maybe would want to get help and now they don't want to come forward because they don't want to be viewed as a criminal. It's a very tough, tough slope to -- I personally feel it's getting that stigma out for people to want to get help. Because there's no way to force help on, we can try hammer the help forcing wise but that's just not the right approach in my opinion.
Ted Simons: All right. Great insight. Good to have you here. Thanks. No problem.

Dr. Michael Yasinski:Psychiatrist, Phoenix;

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