Governance of Violence Risk in Patients with Severe Mental Disorders: From a Case of a Schizophrenic’s Filicide

Abstract

Schizophrenia is a chronic, prolonged illness with a significant tendency to relapse and a high disease burden. Patients are often affected by psychotic symptoms and commit violent assaults that manifest as criminal acts. At the same time, such patients generally have poor medication adherence, which also makes them more likely to commit crimes. In our case, a single mother with a history of psychiatric illness strangled her 4-year-old biological son to death with a rope, put the body in a bathtub and divided it, ate some of the victim’s organs; the results of her forensic mental health identification indicated she was in a period of illness at the time of the offense and did not have the competence for criminal responsibility. Medication adherence is an important factor affecting relapse in patients with schizophrenia. Although new medications have been introduced and researchers have been improving medication adherence through many ways such as patient education and family therapy since the 1980s, the level of medication adherence is still poor, with a nonadherence rate of about 50%. This report suggests that in practice, attention should be given to improving patients’ medication adherence, guardians of patients and their communities should strengthen their monitoring and care, including knowing the patients’ medication adherence and monitoring them to take their medication as prescribed, together with systematic psychotherapy for patients to prevent them from relapsing and committing violent attacks. Besides, when assessing the patient’s risk of violence, the realistic factors in crime motives and the impact of guardians (family) should be taken into account to evaluate the risk of violence objectively and comprehensively. A final point is that social support for patients with mental disorders and their families should be improved.