• Would improving mental health care reduce homicide rates?

    Once again, a young man with mental health problems has committed multiple homicides. Would reforming the mental health care system prevent some of these tragedies?

    Steven Segal looked at whether differences in mental health systems across states were associated with differences in homicide rates. He asked whether states that have laws with broad criteria for involuntarily committing a person into mental health treatment had fewer homicides. Broad criteria means that it is easier for doctors to justify commitment orders. This might make it easier for families to get troubled young men like Elliott Rodger into treatment.

    Many families and advocates for people with serious mental illness say the country needs to change its standard for civil commitment, which allows people to be hospitalized against their will.

    Changing these laws could help provide treatment for people like Elliot Rodger, 22, who police say stabbed or shot six people to death near the University of California-Santa Barbara, says Doris Fuller, executive director of the Treatment Advocacy Center, a mental health advocacy group. Although his family had asked police to check on him, officers decided he wasn’t a threat and made no arrest.

    Fuller says states should make it easier for families to petition for involuntary commitment when they are worried about a loved one’s health.

    Would laws like this actually help? Here’s what Segal found:

    Purpose. The study considers whether involuntary civil comment (ICC) statute provisions are associated with homicide rates. Do statutes based solely upon dangerousness criteria versus broader ICC-criteria—i.e. ‘‘need for treatment,’’ ‘‘protection of health and safety,’’ and family protection–have differential associations related to their goal of reducing the frequency of homicide?

    Method. State-level data were obtained from online data bases and key-informant surveys. Ordinary-least-squares and Poisson regression were used to evaluate the association between statute characteristics, mental health system characteristics, and 2004 Homicide Rates after controlling for firearm-control-law restrictiveness and social-economic- demographic-geographic-and-political indicators historically related to homicide rate variation.

    Results. Poisson and OLS models, respectively, were significant: likelihood ratio = 108.47, df = 10; p < 0.000 and Adj. R2 = 0.72; df = 10, 25; F = 10.21; p<0.000. Poisson results indicate that social-economic-demographic-geographic-and-political-indicators had the strongest association with state homicide rates (p < 0.000). Lower rates were associated with: broader ICC-criteria (p < 0.01), fewer inpatient-bed access problems (p < 0.03), and better mental health system ratings (p < 0.04).

    OLS results indicate that social-economic-demographic-geographic-and-political indicators accounted for 25% of homicide rate variation. Broader ICC-criteria were associated with 1.42 less homicides per 100,000. Less access to psychiatric inpatient-beds and more poorly rated mental health systems were associated with increases in the homicide rates of 1.08 and 0.26 per 100,000, respectively.

    In summary, states that make it easier to commit people into mental health care have lower homicide rates. The difference of 1.42 less homicides per 100,000 is meaningful when you consider that the average 2004 homicide rate in the jurisdictions with commitment statutes was 4.51 ± 2.27 per 100,000. There was also a small association between having more inpatient mental health beds and lower homicide rate.s

    However, this is not a strong study design. What Segal showed was that there was a correlation between a state’s commitment laws and its homicide rate. This doesn’t necessarily mean that broader commitment criteria cause reductions in homicide rates.

    So be cautious about arguing that making it easier to commit people or improving mental health care will reduce our homicide rate. It might, but we really don’t know.

    Most importantly, recognize that people with mental illness are not a significant threat to you. Tens of millions of Americans have diagnosable mental illnesses and, just like their neighbors, very few of them have a history of violence. The chances that you will be killed by a mentally ill stranger are negligible.

    @Bill_Gardner

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