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Health Mythbusters is a regular column in which Dal Health researchers challenge widely held beliefs about health issues. This month, Dr. Crystal Dieleman discusses the criminalization of mental illness.

Dr. Dieleman is an Assistant Professor in the School of Occupational Therapy. Her research interests include understanding how to prevent and reduce the criminal justice involvement of people with mental health problems, understanding and improving mental health care in criminal justice settings, and defining and building the potential role for occupational therapists in supporting people involved in the criminal justice system.    

What would you say is the focus of your work?

The focus of my work has been on the criminalization of mental illness — individualizing the problem to the person. When a person who has mental health concerns becomes involved with the criminal justice system, the person’s health and wellness is only one part of the story. Research indicates that prior to these incidents, individuals and their families often try to get help, and can’t get the help they need when they need it. The mental health concerns weren’t addressed because often, there needs to be some type of crisis before people can access services.

What are some of the key misconceptions surrounding the relationship between mental health and violence?

People can have an exaggerated view of the relationship between mental illness and violence, and also about the risk of being personally harmed by a person with mental illness.

Despite the over-representation of people with mental illness in our jails and prisons, mental health concerns are not related to violence; there is no clear correlation. But there is a correlation between people being isolated and excluded from their community and violence. Often, when person with mental health concerns commits a violent act or comes into contact with the criminal justice system, the person has been excluded or isolated socially and was not able to access services or supports before a crisis occurs.

Where do these misconceptions come from?

We are in the midst of a social media and fake news explosion, often without checks and balances for accuracy or ethics, which can create the image of people with mental health concerns as monsters, or dangerous. The media tends to focus on, and exploit, extremely tragic and violent events involving people with mental illness, despite the fact that these events are relatively rare. This has resulted in us, the general public, having an exaggerated perspective on the relationship between mental illness and violence.

What’s the reality for those with mental illness who become involved in the criminal justice system?

It’s important to remember that we’re talking about people — not a label, or diagnoses or psychiatric jargon — and some people get sick. In Canada, 1 in 5 people will experience a significant mental health concern in their lifetime, so the odds are that most if not all of us know someone who experiences mental health concerns.

Sometimes, people with a mental illness may be involved with the criminal justice system, but will not have committed a crime. Police may be called because a person is expressing suicidal thoughts, or maybe someone is seen to be acting in an odd or disruptive way, and it is assumed they are dangerous and police are called.

There are people who have mental illness who do engage in violent behaviours, but not any more than people who don’t have a mental illness – mental illness is not a predictor of violence. In fact, people who have mental illness are more vulnerable in terms of being victims of violence themselves, than to commit these acts.

What are the factors that can contribute to violence?

While mental illness is not a predictor of violence, we know that excluding people is. There is stigma around mental illness, and people with mental health problems face discrimination. When we aren’t comfortable around someone and exclude them or make them feel unwelcome, for whatever reason, we are saying to them that we don’t value them as a human being.

And so we default to the NIMBY syndrome – Not In My Backyard. We may feel compassion for people who need a place to live, or work, but we don’t necessarily want them living and working near us. In this way, we can deny people with mental health concerns what they need most, and they can become isolated, marginalized, and increasingly vulnerable. Without services or support from the community, these are factors that can contribute to individuals acting in socially unsanctioned ways, sometimes violent or aggressive ways, and then being subject to the criminal justice system instead of accessing the health or social systems that would address their actual needs – the social determinants of health.

What’s the biggest myth about the connection between mental illness and violence?

The biggest myth is that the solution is to “lock them away forever and throw away the key” — whether it’s in a psychiatric facility or jail. We have to get past the idea that incarceration is an appropriate response to social and health problems. Hand in hand with that is the myth that whether or not a person has a criminal record is an appropriate standard for determining whether or not a person should be included in our communities.

Put it this way: Think of the worst thing you have ever done. What if that thing was the only factor anyone ever used to decide if you get access to education, or a job, or whether you get to live in the community. You are so much more than the worst thing you’ve ever done.

Find out more:

Watch Dr. Dieleman’s TEDx Talk