Dare to Ask: What to do when someone you know is mentally ill and violent

By Phillip Milano

The Florida Times-Union

Question

I befriended a paranoid schizophrenic, and he has accused my mother of saying something bad about him. When I protested, he pulled a knife and threatened to stab me. His parents told me he doesn't take his medication and drinks alcohol, which makes him irrational or violent. Could his psychiatrist be held responsible for his actions?

Tony, 41, Bronx, N.Y.

Replies

I have been surviving with a schizoaffective disorder 17 years. Your friend is fully responsible for his own actions unless he is a minor.

Jim, 35, Knoxville, Tenn.

What a horror. You need to talk to a lawyer or someone at your local police station.

Laurie B., Boston

Can he be "sectioned" (involuntary committal)? In Canada ... a person is committed if they are a "danger to themselves or others."

Ana, 37, Langley, Canada

I once went with a man with the same disorder. He was always making accusations. The relationship was over quickly. However, he had a hard time accepting it and kept calling me. It can be painful when you feel there is nobody around, but unfortunately they bring their trouble on themselves. They need a strong person to help them with a hand up.

Mary, Green Cove Springs

Experts say

Generally, if you're diagnosed with schizophrenia or another serious mental illness, you're still legally responsible for your behavior, said Ron Honberg, legal director for the National Alliance on Mental Illness.

Exception: Let's say the person really deteriorates. All states have laws that let people be involuntarily committed if they're deemed a danger to themselves or others, or are gravely disabled, Honberg said. Or, they may be adjudged incompetent enough that they need a legal guardian.

So is that guardian culpable for someone else's violence? Not usually, but if they knew the person was going to behave violently, could have prevented it and did nothing, some courts have held them accountable.

As far as doctors, they generally aren't criminally liable, either. In one case in California, however, a guy told his psychiatrist he was going to off his ex-girlfriend, and the caregiver didn't warn the woman. After she was killed, her family won a civil judgment against the doctor because the court found he had a "duty to warn," Honberg said.

There's also the issue of psychiatric malpractice, but it's rare to win a case against a doctor unless he or she makes an "egregious departure" from accepted practice, he said.

All in all, the best way to respond to a violent situation is to get caregivers and local authorities involved early on, said Julia Shimizu of California, whose 25-year-old son is diagnosed with schizophrenia.

"One time, our neighbors had to call the police ... they came and were able to de-escalate things because they had received proper training. That works miracles. And it couldn't have happened if I hadn't created a relationship with police in advance."

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Phillip Milano, author of I Can't Believe You Asked That! (Perigee), moderates cross-cultural dialogue at Y? The National Forum on People's Differences. Visit www.yforum.com to submit questions and answers. Send general column comments to phillip.milano@jacksonville.com. You can also hear his podcasts or watch his TV spots.