EDITOR’S NOTE: This is the first of a two-part series about addressing mental health issues in East Texas.
As members of the Smith County Behavioral Leadership Team prepare to move toward action items in an effort to establish a mental health crisis center here, they continue to emphasize the importance of eliminating stigma.
These days, dialogue about the need for improved mental health care systems tend to follow acts of violence that gain national attention, such as mass shootings.
There were 345 reported and verified mass shooting incidents in 2017, according to Gun Violence Archive, an independent data collection and research group.
After each incident, the narrative was almost always the same: Do something about mental illness to prevent future occurrences. News reports often center on legislators who suggest they provide more funding for mental health programs.
While it's always a good time to discuss the need for increased access to mental health care, using mental illness as a scapegoat for violent acts does more damage, mental health advocates said.
"This is one of those things that has really bothered me," said Doug McSwane, co-chairman of the Smith County Behavioral Leadership Team. "The only time we hear about mental illness is when there is a shooter. The automatic assumption is that he's mentally ill."
The truth is that the majority of all types of violence in the United States are committed by people who do not have a mental illness.
Less than 5 percent of the 120,000 gun-related killings in the U.S. between 2001 and 2010 were committed by people with a diagnosed mental illness, according to an American Journal of Public Health study.
And in a study published in the Annals of Epidemiology, "evidence suggests that even if we could completely eliminate mental illness as a violence risk factor, the population prevalence of violent acts toward others would go down by less than 4 percent."
"In general, the factors linked to shootings are more about a history of violence and early life abuse," said Dr. Richard Idell, a behavioral health expert who specializes in adult and child and adolescent psychiatry at UT Health Northeast. "Other factors are alcohol dependency and being male. Those are really more indicative of individuals who are more likely to commit acts of violence than those having bipolar disorder, schizophrenia or depression."
People with a mental illness also are slightly less likely to have a gun when compared to those without mental illness, according to information cited in the Annals of Epidemiology. In addition, people who reported a previous suicide attempt were significantly less likely to have access to a gun than those who'd never attempted suicide.
Being subjected to negative perceptions is a reality for families who work tirelessly to ensure the quality of life for loved ones diagnosed with a mental illness. It could even hinder them from getting help, one family member said.
"Who would want to come forward and say, "I have schizophrenia?" McSwane said.
There is always a need to protect loved ones who have a diagnosed mental illness. It's why McSwane said his family remained quiet about his late son's schizophrenia.
"We didn't tell anybody, just immediate family," McSwane said, whose son, Patrick, too his own life in 2012.
The McSwane family has since spoken candidly about Patrick's struggles in hopes of eliminating stigma in East Texas.
Tyler resident Cynthia Davis— the mother of 22-year-old Ty, who has a severe mental illness —worries about the safety of her son when she hears narratives connecting mental illness with violence. She was incensed when mental health dominated news reports following the November church shooting that left 26 dead in Sutherland Springs, Texas.
"I'm a witness that it brings on more stigma on people who are mentally ill," Mrs. Davis said. "With my son, over the years, whenever someone does something like (a mass shooting), I notice people shy away from him and become afraid of him. But he's not a violent person.
“People have told me I should be afraid,” she said. “We're not afraid of Ty.”
But she does fear for his safety. Studies show that people with a mental illness are more likely to be victims of violence. Ty Davis has been bullied, beaten and had things stolen from him over the years, his mother said.
"You're scared the police are going to kill them," Mrs. Davis said, recalling an incident that called for an encounter with law enforcement. "You're afraid if they're walking down the street talking to themself. They go to school and people don't want them there. They have weird behavior everywhere you go. If people find out they have mental illness they have fear."
Mrs. Davis' 57-year-old brother, a military veteran with a history of mental illness, is also taken advantage of, she said. She said her son and brother internalize that abuse and place blame on themselves. They are more susceptible to harming themselves than anyone else.
"They cower,” Mrs. Davis said. “They don't fight back. The family has to deal with the sadness. They do become suicidal and end up in the hospital, on more medications."
People with a mental illness are at greater risk of suicide. Awareness about mental illness and suicide is important here, as East Texas counties lead other areas of the state in suicide rates and access to mental health resources is scarce.
Mental health professionals said there is at least one way to drastically change the course of the dialogue about mental health and to help people be less fearful of those with a diagnosed illness.
"Education in general is an important part of the solution," Idell said. "Education could be better at the school level and community in general. We have to teach the difference between those who are predisposed to mass violence and those who suffer from depression, anxiety or bipolar disorder.
“If people understand that, the less bullying you'll have and schools can look for certain issues,” he said. “It's the key to decreasing stigma among individuals, even for adults. For adults, it can be challenging.”