Schizophrenia and Predicting Future Dangerousness

August 8, 2012

thejbmission asked an excellent question about schizophrenics and why our legal and mental health systems wait until after a tragic event occurs before doing anything to prevent it.

The short answer is mental health experts cannot accurately and reliably predict future dangerousness by schizophrenics. They are as likely to be right as they would be if they flipped a coin.

Most people afflicted by schizophrenia are not violent and, since they are not a danger to themselves or to others, they cannot be involuntarily committed to a secure mental health treatment facility. Without medication they are often delusional and when they are delusional, they cannot hold a job. The antipsychotic medication that keeps the delusions at bay has unpleasant side effects, however, that leave them feeling deadened like zombies. Families can do little to help them and they are often homeless wandering aimlessly about our cities talking to the voices no one else can hear. They occasionally commit petty crimes to survive and when they do, they are likely to be arrested and taken to jail. They plead guilty, are sentenced to time served, and released to the streets to begin the endless cycle anew.

Our mental health laws prohibit involuntary commitments unless a mental health professional, who typically is a screener at a hospital ER, finds probable cause that the person is dangerous to himself or to others. Such a finding usually results after an attempt to commit suicide.

The involuntary commitment is limited to 72 hours and cannot be extended unless approved by a judge following a hearing. The patient has a right to be present at the hearing and represented by counsel. If the judge finds probable cause to believe that the patient is a danger to himself or to others, the involuntary commitment will be extended for a period of 30 days and, upon review, may be extended for another 30 day period, etc.

Most people are released after the 72 hour period.

Predictions by mental health experts regarding who will commit acts of future violence are about as likely to be accurate as a coin flip. Therefore, there is no factual, medical or legal justification for singling out anyone, whether schizophrenic or not, and confining them for any reason for any length of time unless, due to a recent event, they are a danger to themselves or to others. That danger must be fact-based and immediate.


Holmes: Why the Prosecution is Waiting to Decide Whether to Seek the Death Penalty

August 4, 2012

James Eagan Holmes has been charged with 24 counts of Murder in the First Degree and 116 counts of attempted murder for killing 12 people and wounding 58 during a shooting spree inside a movie theater at the midnight showing of the new Batman film, Dark Knight Rising.

Facts are difficult to come by because the Court “has issued a gag order on lawyers and law enforcement, sealing the court file and barring the University of Colorado, Denver from releasing public records relating to Holmes’ year there as a neuroscience graduate student.”

I have written two articles about the case here and here reviewing the potential civil liability of the University of Colorado to the victims of the shooting spree for the alleged failure of its employees, psychiatrist Dr. Lynne Fenton and the members of the university’s threat assessment team to warn the police about a possible threat to harm people that Mr. Holmes may have expressed to Dr. Fenton on or about the day that he formally withdrew in early June as a student in a Ph.D. program in neuroscience.

Probably due to the Court’s gag order, the school has not yet disclosed the specifics of Mr. Holmes’s statement to Dr. Fenton. All that we know so far is that she attempted to convene the mental health clinic’s threat assessment team to review what he said, but the team declined to do so because he had withdrawn from the school.

As I explained in my two articles, given the restrictive and limiting language in the Colorado statute, I believe it is unlikely that the university will be held liable to the victims of the shooting for failing to warn the police about Mr. Holmes. We will have to wait and see what Mr. Holmes said to Dr. Fenton before we can definitively wrap up this discussion.

Now I want to discuss a different subject in the case; namely, the death penalty. The prosecution has charged Mr. Holmes with two murder counts per homicide victim. The two charges contain different elements and basically allege two different ways to commit the same offense. CBS News explains:

Holmes is facing two separate charges for each person killed or injured. The second charge for each alleges that in killing or injuring, Holmes evidenced “an attitude of universal malice manifesting extreme indifference to the value of human life generally.”

The prosecution announced shortly after filing charges against Mr. Holmes, that it has not yet decided whether it will seek the death penalty, if Mr. Holmes is convicted of murder.

Translated into the language we speak, that means it is waiting for the defense to complete its mitigation investigation and submit its report to the prosecution to consider in determining whether to file a notice that it will seek the death penalty.

Mitigation evidence is any evidence about the defendant or the crime he committed that in fairness or in mercy calls for a sentence of less than death.

Mr. Holmes appears to suffer from a serious mental illness, possibly a type of schizophrenia. The defense likely has assembled a team of mental health experts who are testing and evaluating his competency to stand trial and well as his mental functioning. No doubt they have been reaching far back into his life collecting all existing school, medical and mental health records.

Mitigation investigation has developed into an art form as well as a necessary and highly specialized skill over the course of the past 30 years. The most common reason for appellate court reversals of death sentences has been ineffective assistance of defense counsel for failing to conduct a thorough mitigation investigation.

A diagnosis of schizophrenia would be powerful mitigating evidence, even if it did not establish legal insanity, because schizophrenia is a debilitating mental disease over which a person has little or no control. Therefore, traditional arguments for the death penalty that are based on the idea of holding people accountable for their actions by sentencing them to death, lose power in the face of evidence that the person is delusional, not like others, and incapable of making responsible decisions on a regular basis. Most people recognize that there is something fundamentally unfair about sentencing someone to death who lacked the capacity to make rational decisions.

Mr. Holmes may also satisfy the test for legal insanity. That is, that he suffers from a mental disease or defect such that he cannot distinguish between right and wrong and conform his conduct to the requirements of law. Insanity is another mitigating factor.

Regardless of his mental condition, however, he committed horrific acts that required sufficient capacity to plan and carry out a moderately complicated scheme.

When the prosecution receives the defense mitigation report, it will submit it to its own panel of mental health experts for review and comment.

Eventually, both sides will meet and engage in serious discussions regarding whether a mentally ill man should be executed or spend the rest of his life in prison without possibility of parole.

Whether the prosecution ultimately decides to file the notice that it will seek the death penalty will depend on the outcome of those discussions and the thoroughness and quality of the defense mitigation report.


Zimmerman, Loughner and Holmes: Are they Evil?

July 28, 2012

James Eagan Holmes allegedly killed 12 people and wounded 58 at the midnight opening of the new Batman film at a movie theater in Aurora, CO.

He had recently dropped out of the University of Colorado Medical School where he was enrolled in the Neuroscience doctoral program and we now know that he was a patient of Dr. Lynn Fenton, a psychiatrist and member of the medical school faculty specializing in the causes and treatment schizophrenia. She also is in charge of Student Mental Health Services.

Given his red and orange hair that he had recently dyed, he apparently believed himself to be or he assumed the role of the Joker, Batman’s arch enemy.

The Telegraph reports:

Police have said that he planned the attack meticulously, ordering ammunition and paramilitary supplies over the internet and buying four weapons legally at gun-stores in the Denver area over two months.

He also rigged his apartment with potentially lethal explosive devices that investigators believe were intended to kill police officers when they arrived to search his home.

The Telegraph reports that Holmes claims he does not recall the incident.

He is scheduled to appear in court Monday at which time he will be formally charged.

Colorado is a death penalty state and likely will seek the death penalty.

Like Jared Loughner, who potentially faces the death penalty for killing six people in Tucson, AZ, including U.S. District Court Judge John Roll and a 9-year-old girl, as well as wounding 14 others, including U.S. Representative Gabrielle Giffords, Holmes may not be competent to stand trial.

A person cannot be tried for a crime unless they are competent to stand trial.

To be competent, they must be oriented as to time and place, comprehend the charges against them, appreciate their legal peril, recall the events that caused them to be charged, and be able to communicate with and assist their attorneys to defend them.

According to the Telegraph, Holmes claims that he does not recall the incident. If that is true, he is incompetent to stand trial.

Should he become competent, he probably will assert the insanity defense.

Colorado combines the M’Naughten Rule with the irresistible impulse rule defining legal insanity as follows:

Whether as the result of a mental disease or defect, the defendant is unable to distinguish between right and wrong and conform his conduct to the requirements of law, or if he can distinguish between right and wrong, is he unable to stop himself from committing the crime.

The biggest stumbling block to satisfying the legal test for insanity is establishing that the defendant could not tell right from wrong. Any behavior that indicates an effort to conceal evidence or the crime itself demonstrates that, however delusional and psychotic a person may have been, they still knew they had committed a crime and sought to escape responsibility for it.

Many people use the word evil to describe people like Jared Loughner and James Eaton Holmes and the acts they allegedly committed.

But what constitutes evil?

Does evil exist?

Is evil something dark and satanic that exists somewhere out “there?”

Does it possess people?

If so, how does that happen?

If it does not exist out “there, where does it exist?”

Are people born evil?

How should the criminal justice system deal with evil, or should it ignore it?

Assuming evil exists, does it increase or diminish personal responsibility for committing crimes?

Assuming for the sake of argument that Jared Loughner committed the crimes charged, is he evil?

If convicted, should he be sentenced to death?

Assuming for the sake of argument that James Eaton Holmes committed the crimes charged, is he evil?

If convicted, should he be sentenced to death?

Finally, what about George Zimmerman?

Is he evil?


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