Recent spree murders have raised the question of making a determination of potential violence or murder and who is most qualified to make it.

The recent murders of people in Maine during a quiet night enjoying the company of their friends and neighbors have raised a number of questions. We know that the man who is seen as responsible for the deaths had been hospitalized for two weeks in the summer of 2023 and, allegedly, he was hearing voices and that he was a gun instructor for military personnel. What questions are lingering in people’s minds?

The first question that arises once anyone sees that he has been hospitalized because he had auditory hallucinations has to be: who interviewed him at the hospital, and how did they make the determination that he wasn’t a danger? We expect that mental health professionals all have superpowers of prediction in these matters, but that is not the case. Judgment regarding dangerousness is never a simple matter; there is no perfect method. The usual rule is: If they were violent or dangerous before, they will probably be dangerous again. But how can anyone tell? They can’t.

I recall my own shock while working at a mental health center. A patient, who was a resident at a home run by the center, attacked a staff member with a kitchen knife. A psychiatrist examined her after a municipal judge ordered her taken to the hospital, where they rejected her admission. The reason given to me? The psychiatrist said the woman said she was sorry. Would you accept that? I asked for the psychiatrist’s complete name and told her I wanted to note it because the woman might attack someone else.

Unless a patient has been exhibiting bizarre behavior on a hospital ward or gives some signs that they may be unstable, discharge is ordered. Additionally, everyone has rights, and keeping someone in a hospital without very solid evidence that has been shown on the unit won’t keep that person confined.

Anyone who would like to review a famous case of hospitalization against someone’s will or necessity is referred to O’Connor v. Donaldson. Donaldson wasn’t dangerous, but he was being kept in a hospital without treatment, and he won his case before the U.S. Supreme Court.

Of course, Donaldson and his attorney argued that he had not received treatment and, therefore, should be released. Why no treatment? Donaldson was refusing all treatment, but that was no reason to keep him hospitalized. He did write a book on his experiences.

The next thing that must be considered relates to how long someone should be held for evaluation. Some states require only three days, but a truly disturbed, psychotic person requires much longer evaluation and treatment. Involuntary commitment laws vary among the states regarding dangerousness and length of stay. Two weeks for someone with auditory hallucinations seems inadequate, and if the voices were of a command nature, the concern would be heightened.

Can a healthcare professional know, for sure, that their decision to discharge is fully validated after interviewing someone? No, because there is no way to know, absolutely, that the person is being truthful. Someone with auditory hallucinations may deny that they are still occurring and present themselves as stable.

Working with psychiatric patients who have committed murder, I saw a number of patients, and all of them had killed family members or someone with whom they were living. But one thread ran through almost all the cases, and the cause was extreme stress, where the person came to believe that death would be the only way to solve the problem. Work-related and financial stress were the two most common causes of their actions.

Keep one thing in mind when you read about a killing: persons with psychiatric disorders are not prone to murder. The current myth that all psychiatric patients are murderers is false, although the most severe form of these disorders is where we may find people more inclined to commit these crimes. The disorder? Schizophrenia is the leading cause when murder and mental illness come to the fore.