Psychotic Disorders: A disease that could lead to imprisonment, not empowerment

Expert opinions describe the accused Tucson shooter, Jared Lee Loughner, as suffering from a psychotic disorder. Various descriptions of Loughner’s behavior before the shooting meet the diagnostic criteria of schizophrenia. Julie Schenecker, the Tampa, Florida mother who recently admitted to fatally shooting her two teenage children in the head, is also described by experts as suffering from a psychotic disorder.

The intersection of psychotic disorders and violent criminal behavior becomes widely publicized in high-profile, mass-murder cases such as these. Unlike any other medical condition, a psychotic episode can result in violent criminal behavior against others. The relationship between mental illness and violence has a significant effect on mental health policy, clinical practice, and public opinion about the perceived dangerousness of people with psychiatric disorders [3]. Violence towards others by a minority of individuals under psychotic distress is a significant public health concern which involves conflicting opinions concerning the right of the patient to treatment, and punishment for the crimes they commit [2] [ 4].

Public discussion to prevent tragedies like the Tucson shooting examines early warning signs of severe mental illness, mental health intervention and the ethics of compulsory treatment in psychiatry [1] [5]. The main consideration regarding preventative measures involves family, friends, educators and mental health professionals initiating intervention and compulsory treatment when obvious psychotic behavior is observed in others.

The emergence of participatory concepts in mental health care creates further considerations that encompass the ability to empower mental health consumers to become engaged in recognizing symptoms, selecting treatment options and working in partnership to develop illness self-management recovery programs [6] [7]. Empowerment concepts are critically needed to strengthen the mental health care system. Innovative strategies targeting informed, safe decisions must be sought in order to involve mental health consumers in the prevention and recovery of psychotic disorders.

1.  Sheehan KA. Compulsory treatment in psychiatry., Curr Opin Psychiatry. 2009 
     Nov;22(6):582-6.

2.  Melamed Y. Mentally ill persons who commit crimes: punishment or treatment?, J Am Acad Psychiatry Law. 2010;38(1):100-3.

3. Elbogen EB, Johnson SC. The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions., Arch Gen Psychiatry. 2009 Feb;66(2):152-61.

4.  Alia-Klein N, O’Rourke TM, Goldstein RZ, Malaspina D. Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample. Aggress Behav.;  2007 Jan-Feb;33(1):86-96.

5.  Kallert TW. Coercion in psychiatry., Curr Opin Psychiatry. 2008 Sep;21(5):485-9.

6.  Scott A, Wilson L. Valued identities and deficit identities: Wellness Recovery Action
      Planning and self-management in mental health. Nurs Inq. 2011 Mar;18(1):40-9.

7. Starnino VR, Mariscal S, Holter MC, Davidson LJ, Cook KS, Fukui S, Rapp CA. Outcomes of an illness self-management group using wellness recovery action planning.  Psychiatr Rehabil J. 2010 Summer;34(1):57-60.

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