Dangerous Criteria

One of the big stories from 2007 in Mental illness revolved around “dangerous criteria,” that is, whether or not to require that individuals be dangerous before treating them for mental illness.

That criterion is meant to protect the public while protecting an individual’s liberty, a fundamental freedom. In the field of mental health, we’re always quick to point out that statistically, individuals with mental illness are far more likely to be a victim of violence, rather than the perpetrator. But it is also statistically true that up to 40% of mass-shootings have been by people with psychiatric disorders.

Is someone undergoing a significant psychotic episode capable of declining treatment? CPR classes don’t cover debating whether a passed out person is dangerous before treatment can be administered.

The argument then against dangerous criteria is that schizophrenia can lead to violence (rarely mass-shootings—but tragically far more often—suicide of the individual with the illness). Also, a recent study by Matthew Large states that in jurisdictions that demand dangerous-based criteria for intervention, individuals who suffer with mental illness go an average of five additional months with no treatment at all (worsening the illness of the individual and despair of the family).

The eventual answer will lie somewhere in a more sophisticated understanding of the cognitive disruptions and irrationality brought on by psychiatric illness—understanding the process and the familiar signs of the illness, followed by the compassion to provide immediate and appropriate treatment.