Mental health: dangerous myths and sad facts

South Africa is a country replete with crime and violence – a cursory look through recent crime statistics will clamp down any debate to the contrary.

However, according to expert forensic psychologists, linking that violence and its perpetrators with mental illness not only adds to the stigma around mental illness, but is simply inaccurate.

October is National Mental Health Awareness Month and ahead of World Mental Health Day (marked on Wednesday this week), experts spoke on the dangers of arbitrarily associating mental illness with violent crime, at a South African Depression and Anxiety Disorder Group (Sadag) workshop held this week.

“Violence happens in context, not in a vacuum. More and more, research is showing us that mental illness in and of itself is not associated with higher rates of violence and is not a good indicator of future violence,” said forensic psychologist Dr Martin Kassen.

In fact, according to Kassen, people living with mental illness tend to be more vulnerable to crimes being perpetrated on them than to committing them themselves.

Kassen’s assertion is supported in a peer-reviewed medical article lead-authored by an American doctor, Norman Ghiasis, titled Psychiatric Illness and Criminality, published earlier this year.

In it, Ghiasis noted that because of the spate of violent mass shootings in America, the relationship between psychiatric illness and criminality has been the topic of intense debate.

“Society at large views behaviour and conduct problems as symptoms of psychological disorders, which has led to the false public perception that equates criminality with psychiatric illness.

Read: Current events could cause a mental health crisis. Can we put a stop to this before it’s too late?

“The high levels of reported mental illness in jail and prison populations are primarily due to false labelling of criminals as having a psychiatric illness. These figures are not always based on thorough medical and psychiatric evaluation and diagnosis, but are rather a result of social factors,” the paper stated.

However, when a person with a mental illness which has caused delusions and paranoia does commit a crime, Ghiasis said that the most important and independent risk factor was long-term substance abuse.

“If you think of someone living with extreme mental illness, the main thing they struggle with is the inability to make informed, voluntary decisions about their everyday life. The greater likelihood is that they’re going to be vulnerable – not that they’re going to jump out of some bush and be violent because a voice in their head (psychosis) told them to. That’s [a distortion] people use to explain things they don’t understand,” said Kassen.

Citing the recent example of Nicholas Ninow – who pleaded guilty to raping a seven-year-old girl at the Dros restaurant in Silverton, Pretoria, in September last year, and whose lawyer stated in November that Ninow had a history of bipolar disorder and substance abuse – Kassen said this sort of psychiatric history was often raised not to absolve the perpetrator, but for judges to have the full context of the offender’s background when deciding on sentencing.

And there was always the chance that a perpetrator was lying.

“However, the rates at which people who are facing trial lie about having mental illness haven’t been recorded. It does happen because the incentive [of a lesser sentence or acquittal] is there, but to a skilled practitioner, it is easy to pick up on the lie,” said Kassen.

Larisa Panieri-Peter, a forensic psychiatrist, raised the issue of stigmatising the mentally ill. She also linked stigma and suicide, the theme of this year’s Mental Health Day.

“We stigmatise the mentally ill, we stigmatise the people who care for the mentally ill and we stigmatise mentally ill offenders. But, most of all, we stigmatise people who commit suicide,” she stated.

Panieri-Peter added that one of the common misperceptions among patients and their families was that suicide was uncommon.

“One of the reasons for that is that we don’t really write about it. Historically, there was a moratorium on it because of a concern of ‘copy-cat’ suicides among teenagers – which is a real thing. However, it’s created this perception that suicide is a highly sensationalised thing and is rare. Somehow we have to change that in order to unlock what it is and how to prevent it,” said Panieri-Peter.

According to Sadag’s operations director, Cassey Chambers, the youngest person in the country known to have ended their own life was a six-year-old boy in Limpopo.

Sadag’s suicide call centre alone received nearly 180 000 calls between January and September this year.

“The government really needs to invest more money in mental health and focus on community mental health services. There also needs to be more training of staff at grassroots level – or, rather, primary healthcare facilities and the inclusion of these services at facilities,” said Chambers.

Vuyo Mkize Health journalist | City Press

+27 11 713 9001 vuyo.mkize@citypress.co.za Media Park, 69 Kingsway Road, Auckland Park

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