By Dr. David Laing Dawson
Though it is true, and has been repeated many times, that people suffering from psychotic illnesses are far more likely to be the victims of crime than the perpetrators, there is a particular kind of violent crime that is usually the product of a psychotic illness. These violent crimes make the headlines because they are shocking and unfathomable. Vince Li kills and cuts up a fellow passenger on a Grey Hound bus. Abdulla Shaikh shoots and kills three different men, strangers to him, in three locations. Kevin Webster kills his mother with an axe while she is sleeping. The month before Moirin (Kevin’s mother) was killed, Kevin was discharged from a treatment program and sent to a shelter.
These three men suffered from schizophrenia. They each had been released from hospital.
When such murders occur it is usually reported that the Police have yet to determine a “motive”.
But such crimes are always the logical consequence of delusional thinking, sometimes compounded by command hallucinations (voices insisting the act be carried out).
The victim is usually a family member. The brutal murder of a mother is often the product of a schizophrenic delusion that mother has been replaced by an evil entity, or is possessed by an evil entity, and the only way to save mother and oneself is to kill this replacement.
Compounding the tragedy of these and similar murders is the fact that we have very effective treatment for schizophrenia. The violent acts mentioned above are the result of either not receiving treatment or stopping the prescribed medication. In most cases the person has been hospitalized recently, and in the past, involuntarily. That is, they have been seen and diagnosed as having a mental illness and presenting a risk to self or others. They have refused treatment or have stopped taking their medication once released from hospital.
We also know that when someone suffering from schizophrenia relapses (having stopped treatment), the same symptoms return, including the same delusion. Even years after the first episode.
As a society we struggle and argue about all possible ways of reducing violence: gun control, longer prison sentences, shorter prison sentences, mental health intervention, housing, security, tighter drug laws, decriminalization of addiction, safe injection sites, education, more police, less police……..
But the one type of violent crime for which we do have a specific and demonstrated prevention is that which is the consequence of psychotic illness.
One component of this prevention can be achieved by retaining involuntary treatment with involuntary admission for mental illness. This ensures that when a psychotic person presents a risk to self or others, treatment of the psychotic illness is started right away.
A second component is the use of community treatment orders to ensure treatment is continued upon leaving the hospital.
A third component (and one that could have prevented the murders listed in the first paragraph) is the use of weekly or biweekly long acting injectable antipsychotic medication.