Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, August 18, 1993 TAG: 9308180135
SECTION: VIRGINIA PAGE: C4 EDITION: METRO
SOURCE: LARRY W. BROWN STAFF WRITER
DATELINE: LENGTH: Long
\ After an 8-year-old boy and his mother were slashed with a knife last month in the Kmart store at Crossroads Mall in Roanoke, it was reported that suspect Jerry A. Jones, 30, had spent time in state mental hospitals. Jones also is scheduled to go on trial for allegedly punching a 16-year-old girl in the face at a bus stop in December.
Last week,, a Roanoke Circuit Court judge ruled that another man, accused of demanding money at gunpoint in the Kroger store at Crossroads last fall, was innocent by reason of insanity. Randy Caine Hayes, 20, who has suffered from schizophrenia off and on for several years, told authorities he was obeying voices that told him to rob the store.
Hayes was shot twice by an off-duty Roanoke police officer. The judge ordered that Hayes continue to receive mental treatment.
Incidents such as these can reinforce the stereotype that mentally ill people are violent. But mental health advocates, and statistics, don't support the stereotype.
"My reaction," said Karl Smith, a counselor at Mental Health Services of the Roanoke Valley, "is the same when the media says a black man did this or a homosexual did that" - more labels that feed stereotypes.
Mental health experts say that predicting violence in people with mental illnesses is difficult at best. Studies show that drug or alcohol abusers are much more likely to be violent than someone who has a mental illness such as manic depression or schizophrenia.
Other factors that help predict violence - such as youth, male gender and lower socioeconomic status - apply to people with or without mental illness. And even with those factors, it usually is impossible to say whether a specific person is going to be violent. Such risk factors simply indicate that a larger percentage of people in these groups will be violent than in the population as a whole.
A recent Columbia University study concluded that people who are in the midst of psychotic symptoms - such as delusions or hallucinations - are somewhat more likely than the average person to be violent. But the study's authors noted that such symptoms are not common and, even when they are present, indicate only a "modest risk" of violence.
The National Mental Health Association, which is based in Alexandria, says that the best predictor of whether a person will be violent is not a history of mental illness but a history of violent acts.
Karl Smith says he has never been attacked in his 14 years on the job as an outreach worker for Mental Health Services.
Despite their confidence that most of the people they counsel are not violent, Smith and his co-workers acknowledge that some can be dangerous.
In fact, Smith and Deborah Johnson, another counselor, both asked that their real names not be used, and their names have been changed for this article. Emergency outreach services' policy is that they do not give out their real names nor reveal the location of their offices to the media, because of fear of threats from people they have had temporarily committed for treatment, or from such patients' families.
"You never know anything about a person, and you never know if they're going to `see' something," Smith said. "I've had people handcuffed to the chair or restrained to talk to them. Sometimes you can tell when someone is getting ready to go off."
John Monahan, a professor of law and psychology at the University of Virginia, says there is no question that alcohol and drugs are more closely related to violence than is mental disorder.
Monahan, along with 11 other researchers and lawyers, has formed a research network that is trying to improve mental health professionals' ability to judge the risk of violence among the mentally disordered. By gathering information on 1,000 mental patients through interviews, police records and hospital records, they hope to determine what factors may have predicted violence. The eight-year study is funded by the John D. and Catherine T. MacArthur Foundation.
"The state of knowledge on how to predict violence is very inadequate. Our crystal balls are very murky," Monahan said.
He said research in the past has shown that psychologists and psychiatrists were accurate one out of every three times that they predicted violence. Two out of three patients who had been labeled as dangerous did not end up doing anything violent, he said.
One aim of Monahan's research is to find out how much difference the patient's medication makes. "We're looking very carefully at drugs in two ways: Seeing whether people are taking illegal drugs, or failing to take their prescribed medication."
Mentally ill people may take drugs or drink alcohol to escape their mental problems, researchers say.
Sometimes the patients will not take the medication because of the side effects, which was the case with Jerry Jones, who is accused of the Kmart knife attack, said Deborah Johnson. "They don't like the medicine. They don't like the way they feel."
Often they carry weapons to defend themselves, Smith said. "Mentally ill people are generally nice people, but your thinking is confused and you don't know who to trust. You get real guarded, and your immediate reaction is to defend yourself."
Sometimes a person will take illegal drugs because he is out of medicine and wants to medicate himself, Smith said, but drugs or alcohol increase the problem. "They don't just get a buzz," he said. "They get paranoid and delusions."
Advocates say that widespread publicity about individual cases of violence reinforces the stereotype that all mentally ill people are dangerous. Monahan believes that the media often bring up a suspect's mental status when it has nothing to do with the alleged crime.
"When there's a publicized incident, it does tend to attract attention and reinforce the stereotype," said Gina White, a spokeswoman for the National Mental Health Association. "People conclude that we need to lock all the mentally ill away. That's the next assumption that's made - that people should just be thrown in hospitals."
Monahan said the vast majority of people who are mentally ill do not need special monitoring when they are outside the hospital. But he said there does need to be a system for assuring care and monitoring in the community for the small minority of mentally ill people who are violence-prone.
White says what is needed is a push for greater community services that will ensure people are taking their medication and getting the help they need.
"So many people are falling through the cracks because the mental health system in general is inadequate," she said.
Staff writer Mike Hudson contributed to this story.
Memo: ***CORRECTION***