Further to the VT tragedy

Discussion in 'Psychiatry' started by halflife, Apr 19, 2007.

  1. halflife

    Joined:
    Apr 13, 2007
    Messages:
    34
    Likes Received:
    0
    Status:
    Attending Physician
    Well, perhaps more of a tangent from that thread. I hope it is not too sensitive a topic at this time for those of you from the US (most, I'm guessing).

    I have quite a bit of background in criminal justice, so I have a particular interest in these types of issues.

    Quite topical here in NZ at present is the impending release of Stephen Anderson, who was responsible for the Raurimu massacre in 1997 - he killed six people including members of his own family.

    He was a diagnosed schizophrenic who failed to consistently take his meds and often self-medicated with illicit drugs (predominently cannabis). He was unlicensed for firearms but as is easy to do if you really want one - he got hold of one prior to a gathering of family and friends.

    He's been incarcerated for just on 10 years, and predictably, there's a fair bit of public outcry that he may soon be released back into the community in some capacity. In fact, it's not just the public - MH professionals are also divided.

    So, there are several points of view,

    a) Perception that he's 'crazy' and may snap again - never released
    b) Perception that his illness is now 'under control' (indicated by 'model patient' beh etc), and he deserves a second chance in the 'real world' due to the mitigating factors of his circumstances, so he should be released
    c) Perception that because he was found guilty by reason of insanity he has served a significantly shorter sentence than someone who was not found to be would have, so he should not be released until he has done his 'real time'

    I suppose one of my questions is: What would happen in a different country in circumstances like this - e.g. the US? How are rulings of insanity tied up with release in murder / manslaughter cases in your country? How do MH professionals view such cases, vs the general public, vs judicial?

    Another question - (while I haven't given you a lot of background, I know) as MH professionals, what's your 'gut feel' on what would be 'right' for an offender like Stephen Anderson who was coming up for consideration for release?

    Interested in hearing anyone's thoughts :)

    (A little info on the current situ: http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10420412)
     
  2. Thread continues after this sponsor message. SDN Members do not see this ad.

  3. whopper

    whopper Former jolly good fellow
    Physician Faculty

    Joined:
    Feb 8, 2004
    Messages:
    6,442
    Likes Received:
    1,072
    Status:
    Attending Physician
    http://www.psychlaws.org/

    This will give you an overview, though maybe too complex for your needs (you'll have to read it for quite some time) to see what's going on in the US.

    Many of the laws vary state to state.

    We also have had this issue brought up in the news several times because our former President Ronald Reagan was shot by someone with mental illness and found not guilty by reason of insanity. The shooter a few years ago was given very minimal standards of security he had to meet because he has showed improvement and this caused a major outcry from those on the political right. (Reagan in the right's mascot).

    In general if someone is considered "stable" for an extended time, their commitment can be diminished or removed. I've seen cases like this happen in NJ. One particular case, a guy murdered his wife, found not guilty by reason of insanity and after 10 years of showing no sx was eventually released.

    A potential problem is that if someone with mental illness is safe with treatment, there are no garauntees they will continue treatment once released. Long term compliance on antipsychotics is low to begin with, with all atypicals being lower than 50% over the course of several months. All atypicals aside from clozaril have long term compliance at less than 40%.

    However, the law & doctors cannot do anything until a patient, compliant or not is dangerous.

    NY has enacted a law allowing for involuntary home commitment. A pt eligible for this is a pt who was dangerous, might not be at that moment when seen by a doctor, but has a high likelihood of becoming dangerous in the near future. E.g. they are known to be noncompliant on meds, declare they will not be compliant, etc. This program allows the state to send people to check on the patients in their homes and the pts must follow speciifc rules such as take meds or immediately become committed inpatients.
     
  4. halflife

    Joined:
    Apr 13, 2007
    Messages:
    34
    Likes Received:
    0
    Status:
    Attending Physician
    Thank you for your response.

    I suppose being from a small country there is less opportunity for precedent to be set in a case such as this as it simply doesn't happen nearly so often. That's one reason I was curious as to US practice / examples.

    Your comment about meds compliance is a natural concern. There has not been much information of the terms and conditions of a potential release, so I do not know where things stand there.

    Thanks again for your thoughts - I wrote more of a reply but I am afraid it was turning quite sociological!
     
  5. halflife

    Joined:
    Apr 13, 2007
    Messages:
    34
    Likes Received:
    0
    Status:
    Attending Physician
    How interesting ...
     
  6. halflife

    Joined:
    Apr 13, 2007
    Messages:
    34
    Likes Received:
    0
    Status:
    Attending Physician
    Thank you for your response.

    I suppose being from a small country there is less opportunity for precedent to be set in a case such as this as it simply doesn't happen nearly so often. That's one reason I was curious as to US practice / examples.

    Your comment about meds compliance is a natural concern. There has not been much information of the terms and conditions of a potential release, so I do not know where things stand there.

    Thanks again for your thoughts - I wrote more of a reply but I am afraid it was turning quite sociological!
     
  7. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
    Physician Moderator Emeritus SDN Advisor

    Joined:
    Dec 2, 2004
    Messages:
    6,048
    Likes Received:
    3,308
    Status:
    Attending Physician

Share This Page