In the aftermath of Saturday's shooting rampage in Tucson, Ariz., that left six dead and 14 wounded, recent reports that alleged shooter Jared Lee Loughner, 22, refused a mental health evaluation after his friends and college administrators expressed worry over the state of his mental health loom large.
Many who interacted with Loughner at Pima Community College believed he was mentally unwell and potentially dangerous. Loughner was suspended after several run-ins with the campus police and the discovery of a disturbing YouTube video, the school said in a statement. He was told his return was contingent on receiving clearance from a mental health professional, but Loughner apparently did not seek help and school officials could not force him to do so.
Like the acts of mass violence perpetrated by schizophrenic unabomber Ted Kaczynski, Loughner's shooting rampage may spur debate over what should be done about people with undiagnosed, untreated mental illness who might pose a danger to society.
Mental health professionals worry that incidents like the Tucson massacre may only spur further stigma against the mentally ill, falsely bolstering an association between violence and mental illness.
"People who are mentally ill are already exposed to a certain amount of stigma. These instances only extenuate that," says Dr. Anthony Lehman, professor and chairman of psychology at the University of Maryland.
"And the stigma often stands in the way of people receiving care," adds Dr. Carolyn Robinowitz, past president of the American Psychiatric Association. "Someone can be told to seek care, and they or their families don't follow up because they are fearful of being labeled. This [incident] can be an opportunity to educate people because we know that the best prevention of violence for those with mental illness is proper treatment."
The mentally ill are slightly more likely to become aggressive or violent, but research has shown that this is almost exclusively in cases where the mental illness goes untreated, or the patient is abusing drugs and alcohol.
"It is true that certain people with mental illness commit violent acts -- partly people who are acutely psychotic or who are using drugs or alcohol. But the vast majority of people with mental illness do not commit violent acts," says Lehman.
Seena Fazel is an Oxford University psychiatrist who has studied the link between mental illness and violence extensively. In a 2009 analysis of past studies on the topic, he found that the relationship between schizophrenia and violence is almost completely determined by drug and alcohol abuse.
Those who do not have severe mental illness but do abuse drugs or alcohol are responsible for a much larger proportion of the violent crimes committed in any given country, Fazel says.
"From a public health and policy perspective, if you want to reduce violence, those to target would be those with drug and alcohol problems," he says.
To put it simply, Lehman says, "Most people with mental illness are not violent, and most violent people are not mentally ill."
For that minority of people with untreated mental illness that may drive them to violence, identifying them and getting them into treatment can be formidable tasks psychiatrists note.