Violence and Mental Health Opportunities for Prevention and Early Detection: Proceedings of a Workshop (2018) / Chapter Skim
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4 Means and Modifiers
4 Means and Modifiers
Pages 35-50
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From page 35... ...
As noted by other speakers in the workshop, people with mental illness are not at higher risk of interpersonal violence compared with the general population, but their risk of self-directed violence is much higher. Thus, speakers discussed how restricting access to lethal means could be a method of reducing the incidence of suicide and self-directed harm.
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From page 36... ...
Other studies looking at interpersonal violence and other mental health issues, including substance abuse, also show that mental-illness-related prohibitions reduce violence in those two groups. In particular, one study looked at perpetrators of intimate partner violence and found reductions in homicide associated with firearm restrictions for those with restraining orders (Vigdor and Mercy, 2006)
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From page 37... ...
. On a similar note, an analysis of gun ownership rates in the 1990s and youth suicide rates showed that suicides decreased dramatically as household gun rates dropped.
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From page 38... ...
He hypothesized that in lowand iddle-income countries with a large agricultural sector, patterns of m pesticide access and use might be a more useful approach to suicide reduction than prevalence and treatment rates of mental disorders. As such, he proposed a set of strategies to address suicide by pesticide poisoning: • Banning the most toxic compounds • Decreasing access to pesticides in the home • Community education about the lethality of these chemicals and about appropriate storage • Improved training and increased access to necessary drugs and equipment for rural primary care health providers While improving medical knowledge and treatment and raising community awareness are important, Phillips asserted that means restriction should be the main focus of efforts to reduce suicide.
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From page 39... ...
Phillips observed that 100 percent compliance is unreasonable to expect, and means restriction needs to be part of a larger overall suicide prevention strategy. Yet, he noted that in low- and middle-income countries, focusing on individual-level mental health approaches might not be the best use of resources.
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From page 40... ...
In most states, he observed, records of purchases of concealed handgun permits are not publicly available. Because he was unable to obtain such records via public inquiries, he instead inquired at police departments and courts for records of people from whom firearms were confiscated for m ental health reasons.
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From page 41... ...
Discussion In the subsequent discussion, workshop participants shared their perspectives on issues raised during the presentations, particularly around predicting future violence and restricting lethal means. Webster noted that, rather than focusing on diagnosis or involuntary commitment to dis qualify an individual from owning a lethal weapon, the focus should be on p otential danger.
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From page 42... ...
• Hypothalamus stimulation. Researchers discovered a locus of aggression in the hypothalamus by injecting a virus carrying a light-sensitive protein into the brain and then stimulating the 6 This section summarizes information presented by Klaus Miczek, Tufts University.
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From page 43... ...
Miczek closed by emphasizing the important role that the mouse model played in teasing apart the various pathways in the brain that result in aggressive behavior, particularly in relation to alcohol consumption, in a manner not possible in human research.
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From page 44... ...
In a study Leonard conducted with his colleagues, couples were queried on alcohol consumption during conflicts involving verbal aggression, moderate physical aggression, and severe aggression. The husband's drinking was strongly associated with severe violence, while the wife's drinking was less clear (Leonard and Quigley, 1999)
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From page 45... ...
As epidemiologist Geoffrey Rose noted, "a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk." The vast majority of health harms in a community arises from a moderate or lower level of risk. This yields two approaches to harm reduction, Nelson noted: the highrisk approach that provides individual-level treatment, and a population-level 8 This section summarizes information presented by Toben Nelson, University of Minnesota School of Public Health.
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From page 46... ...
Alcohol Policy: Challenges and Successes in Latin America9 In terms of the global burden of disease, alcohol has higher impacts in countries in Latin America than in the United States or Europe. In Brazil, an 9 This section summarizes information presented by Ronaldo Laranjeira, Universidade Fed eral de São Paulo and National Institute on Alcohol and Drug Policy, Brazil.
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From page 47... ...
Ronaldo Laranjeira further described the unregulated market in Brazil: There is no licensing requirement to sell alcohol, resulting in nearly 1 alcohol outlet per 200 people. In addition, an estimated 30 percent of drivers on weekends are intoxicated, and there is little restriction on adolescent purchase of alcohol.
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From page 48... ...
2005. Alcohol consumption and intimate partner violence by alcoholic men: Comparing violent and nonviolent conflicts.
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From page 49... ...
2003. Homicide and suicide risks associated with firearms in the home: A national case-control study.
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