The use of psychiatric assessments, mental health courts, and forced psychiatric treatment, have the mental health and justice systems in shambles and continue to put the community at risk. While psychotropic drugs and treatments are increasingly linked to acts of senseless violence, psychiatry admits its inability to predict dangerousness.
By Jan Eastgate
President, CCHR International
September 9, 2022
CCHR International has been reviewing psychiatrists’ inability to predict violence as part of its investigation into shockingly violent crimes committed by those who were taking or withdrawing from psychotropic drugs or who had undergone mental health treatment and hospitalization. In a sample of over 125 documented cases since the late 1980s, CCHR found numerous instances where psychiatrists evaluated and determined that the perpetrator, who had usually already received treatment, was not a threat to others, yet went on to kill.
While studies show that treatment may more likely induce violent behavior than prevent it, which many psychiatrists refuse to acknowledge, at the same time they admit that they have no way of predicting dangerousness. Stephen D. Hart, a psychologist at Simon Fraser University in Vancouver commented on this, stating: “There is no instrument that is specifically useful or validated for identifying potential school shooters or mass murderers.”[1]
A study conducted by a group of lawyers and psychologists and published in February 2020 in the journal Psychology Science in the Public Interest found that many tests used in courtrooms are considered scientifically unreliable; in the headline, the journal dubbed them “junk science.” Eric Drogin, a forensic psychologist and lawyer, who teaches at Harvard Law School and who was not involved in the study, stated: “It should not come as a surprise to any attorney or scientist who works in this area.” His analogy for psychiatry’s “forensic tests” equated them to the days of dunking alleged witches in water to see if their bodies would float. If they floated, it was considered evidence that they were witches. However, the “test,” he said, “was measuring buoyancy and not witchcraft.”[2]
According to the American Psychiatric Association’s own Diagnostic and Statistical Manual of Mental Disorders, the book is “not sufficient to establish the existence for legal purposes of a ‘mental disorder,’ ‘mental disability,’ ‘mental disease,’ or ‘mental defect,’” in relation to competency, criminal responsibility or disability.[3] Case in point was a man who shot at 9 people, killing 4, including a 16‐year‐old girl. Attorneys asked a psychiatrist, “How well can you or any other psychiatrist or doctor predict the future conduct of another human being?” The psychiatrist responded: “Poorly. Psychiatry is a very inexact discipline. And the data that we do have about prediction indicates that the long‐term prediction of violence is more often wrong than right.”[4]
Yet, the insanity defense, as supported by psychiatric “expert” testimony, has been used in numerous trials involving school or community shootings. Found incompetent to stand trial or guilty but “mentally ill,” perpetrators can be sent temporarily or long-term to a psychiatric facility to be forcibly drugged until they are deemed competent to stand trial or can be released. In one case, this cost to the state was close to $350,000 for psychiatric treatment over several years.[5]
Defendants deemed “mentally ill” can now also have their cases sent to mental health courts for trial of misdemeanors, but these courts have become conduits to forced treatment that includes hospitalization and “ongoing follow-up treatment and medication.”[6]
It’s a revolving door that generates more forced treatment, more violence, and more opportunities for psychiatrists to fail the legal system and society in general.
From “Treatment” to Executions
CCHR points out another irony of psychiatric “medications” in that some are also used in executions. On the one hand, the drugs are advocated as therapeutic but they can cause violence, leading to crimes being committed and criminal prosecution. And on the other end of the spectrum, they are used on death row.
In February 2022, the execution of Zane Michael Floyd was stalled because state officials were unable to secure sufficient vials of the sedative ketamine, one of three drugs used in Nevada executions.[7]Ketamine, an anesthetic and hallucinogen, is prescribed off-label (not Food and Drug Administration approved) to treat depression. It is also used in the administration of brain-damaging electroshock treatment. Floyd, a former marine, was convicted of the June 3rd, 1999 shooting at an Albertson’s supermarket when he killed four and injured one. He was 23 years old. He’d been treated by psychiatrists from at least the age of 13. Dr. Norton Roitman, a psychiatrist who treated Floyd at the time, testified in court that Floyd had been taking Ritalin, a stimulant used to treat “attention-deficit disorder,” but because it was not “working,” he changed it to an antidepressant—despite antidepressants documented to induce suicidal behavior in those younger than 24.[8]
Other cases of note include those with long histories of being assessed and treated by psychiatrists, with their emerging violent tendencies missed or ignored:
- May 14th, 2022: In Buffalo, New York, Payton S. Gendron, 18, targeted African Americans when he fatally shot 10 and injured 3 at a local grocery store.[9] In 2021, Gendron had made a “murder-suicide” threat while attending his high school, at which point he was referred for mental health evaluation and services. He was held in a psychiatric facility for three days and then released, as the psychiatric opinion was that the threat was insufficient to warrant further action.[10]
- February 25th, 2022: In Aurora, Illinois, Gary Martin, 45, shot and killed five co-workers and wounded five police officers at a manufacturing company. He had a prior conviction in 1995 for beating his then-girlfriend with an aluminum baseball bat and stabbing her, for which he was sentenced to five years in prison. A court-ordered psychiatric evaluation at the time determined Martin did not pose a threat to the general public at that time, although Martin, then 22, told the psychiatrist, “I have a problem controlling my temper … when I get real upset.”[11] In his report, the psychiatrist admitted: “Mental health professionals are not able accurately to predict remote future dangerousness” and “I cannot say whether or not Mr. Martin will become violent again in the future.”[12] Less than a decade later, Martin continued his acts of senseless violence, this time fatally. He was released after serving less than three years in prison.[13]
- November 30th, 2021: Ethan Crumbley, 15, entered his high school in Oxford Township, Michigan and shot and killed four students and injured seven others and a teacher.[14] School behavioral staff had interviewed the teen on the day before and on the day of the killings about reported violent behavior and allowed him to return to school. The school superintendent noted: “At no time did counselors believe the student might harm others based on his behavior, responses and demeanor, which appeared calm.”[15]
- August 20th, 2021: In South Haven, Michigan, Aidan Ingalls, 19, a high school student, fatally shot one person and wounded another before committing suicide. In 2018, he pleaded guilty to two firearms and explosives-related felonies in juvenile court and was sentenced to spend a year in a residential treatment center. He underwent several psychiatric evaluations. Recommendations included: continue the antipsychotic risperidone and consider the antidepressant Zoloft for anxiety. On November 4th, 2019, Ingalls was released from an inpatient facility on probation. Within nine months, he went on his final and fatal shooting spree.[16]
- May 20th, 2018: Dimitrios Pagourtzis, 17, entered Santa Fe High School in Texas where he shot and killed nine students and a teacher, and injured 10 others. Although any potential psychiatric treatment is unknown, in 2019, he was found incompetent to stand trial and sent for treatment at a psychiatric facility with the view of him becoming “competent.” However, much to the upset of the families of his victims, a judge ordered him to remain at a mental health facility for another 12 months.[17]
- February 14th, 2018: Nikolas Cruz, 19, went to his alma mater, Marjory Stoneman Douglas High School in Parkland, Florida, and gunned down former classmates and teachers, killing 17 and injuring 15.[18] He’d been on and off psychiatric drugs since the age of six and had also been evaluated numerous times by psychiatrists and psychologists. Dr. Brett J. Negin, a psychiatrist who treated Cruz from 2012 to August 14, 2017, prescribed him several psychotropic drugs, including the antipsychotic Risperdal, and said he didn’t see any indication of violence. [19] However, in 2014, another psychiatrist and school therapist warned that Cruz had a “preoccupation with guns and the military and perseverates [speaks often] on this topic inappropriately,” that “he dreams of killing others and is covered in blood” and his mother feared he was armed with “a hatchet.”[20]
- July 20th, 2012: James Holmes, 24, went on a shooting spree at a movie theater in Aurora, Colorado, coldly executing 12 people and injuring 70 more. He had been prescribed the antidepressant sertraline (Zoloft) and the antianxiety drug clonazepam (Klonopin). The dosage of the antidepressant had been tripled from 50mg to 150mg per day over several appointments. Holmes was displaying “psychotic level thinking. Guarded, paranoid, hostile thoughts he won’t elaborate on.” [21] In 2022, Holmes’s treating psychiatrist, Lynne Fenton, said she saw him seven times over several months, and “He said he had thoughts of killing people,” but she saw it as a “vague and bland statement.” She even asked him: “If you were to do this, do you have an idea as to how you would do it.” He told her he didn’t. Further, “I asked him if he had guns and weapons. He said no, and that turned out to be a lie.”[22] In the marketing for her book about her treatment of Holmes, it said, “She feared he was going to kill. Yet she could find no way to thwart him.”[23]
Such glaring examples are a testament to the need for courts to cease relying on psychiatric “expertise.” And are further evidence that psychiatric treatment, especially drugs, does not prevent violence but is a contributing factor.
This is also why psychiatric assessment and the inability to predict and prevent murderous outcomes, as well as “treatment” that includes psychotropic drugs that can potentially create or exacerbate troubled mental states, should be eliminated from our criminal judicial system.
Psychiatry Creates Burgeoning Prison Population
It is no wonder we have a burgeoning prison population with a reported 43% of persons incarcerated in state prisons diagnosed with a “mental disorder.”[24] In California, that figure was around 29% in 2020, with $758 million allocated for prison mental health services.[25] The federal Bureau of Prisons (BOP), our nation’s largest prison system, spent more than $36.5 million on psychotropic drugs to treat thousands of offenders over four years. In 2016 alone, BOP spent about $72 million on psychology services and $5.6 million on psychotropic drugs.[26] In 2012, nearly 20% of the $144.5 million ($28.9 million) that California prisons spent on pharmaceuticals were for antipsychotic drugs alone.[27]
On the other hand, governments have been led to believe that Mental Health Courts will give access to mental health treatment, that this intrinsically means people will be helped, and that this will reduce both crime and the prison population. But this is without evidence that treatment prevents future crime or improves community safety. Today more than 450 adult mental health courts exist in 45 states across the U.S.[28] In California, Eric Harris, public policy director at Disability Rights California stated: “In no way should there be a forced situation where you’re shoving needles into people or forcing them to take medication, that’s where you get into people who resent it and regret it and they go down a spiral of self-medication or any other number of issues.”[29]
A 2014 report, “A Client Perspective of Mental Health Courts and the Use of Force and Coercion,” reported: “Mental health services in this country consist mainly of voluntary and involuntary inpatient stays, diagnosing, prescribing daily psychiatric drug regimens, day programs, entitlements, electroconvulsive therapy and ‘treatment’ that is either forced or coerced.” Further, “The outcomes of this approach have resulted in a 25-year reduction in life span for people receiving public mental health services, according to a study led by Dr. Joe Parks for the National Association of State Mental Health Program Directors. It has also significantly increased the number of people on Social Security Disability Insurance, the suicide rate, the incarceration rate and the homelessness rate, according to the National Association For Rights Protection And Advocacy and others who have studied results of mental health treatments. The most detrimental ramification of the current approaches to mental health services and treatment is that they tend to deprive hope.”[30]
The report said mental health courts should not be used for people “being forced or coerced into treatment that doesn’t work. It should not be the court of ‘compliance.’… Mental health courts are courts of force and coercion and are indicative of treatment failure and should not be used. Force isn’t treatment.”
United Nations and World Health Organization reports and guidelines concur that coercive psychiatric practices must be removed from the mental health system. [31]
Remove Psychiatry from the Criminal Justice System
CCHR’s co-founder, the late Thomas Szasz, a professor of psychiatry, was uncompromising on the need to also remove psychiatry from the criminal justice system: “The introduction of psychiatric considerations into the administration of the criminal law—for example, the insanity plea and verdict, diagnoses of mental incompetence to stand trial, and so forth—corrupt the law and victimize the subject on whose behalf they are ostensibly employed.”[32]
This information is not to excuse violent crimes and make the perpetrator blameless, but to demonstrate why there may be a much different type of violent behavior that police and the community face today compared to 50 years ago. If criminals are able to evade the consequences of their actions through this type of perversion of the principles of justice, then the very tool that society relies on to protect itself has been obliterated. This is also why psychiatric assessment, “treatment” that includes psychotropic drugs that can potentially create or exacerbate troubled mental states, and the inability to predict and prevent murderous outcomes, should be eliminated from our criminal judicial system.
[1] https://www.cchrint.org/2022/05/23/mental-health-month-spotlights-failures-more-acts-of-senseless-violence/, “Predicting violence is a work in progress,” Washington Post, 3 Jan. 2013
[2] “A New Study Challenges the Reliability of Court Psych Exams: A team of lawyers and psychologists reviewed 364 exams used in the legal system, finding a third of them don’t pass muster with forensic mental health experts,” Wired, 2 Mar. 2020, https://www.wired.com/story/a-new-study-challenges-the-reliability-of-court-psych-exams/
[3] Diagnostic and Statistical Manual of Mental Disorders Fourth Edition-TR, (American Psychiatric Association, 2000), p. xxxiii
[4] “ONCE A KILLER; A GUNMAN CONVICTED OF SHOOTING NINE PEOPLE AND KILLING FOUR OF THEM IS TRYING TO BE RELEASED FROM A MENTAL HOSPITAL,” 48 Hours, 12 July 1999
[5] Ted Oberg and Sarah Rafique, “’Slap in the face:’ State spends $350K on accused Santa Fe shooter while families wait,” ABC Eyewitness News, 20 May 2021, https://abc13.com/sante-fe-texas-shooting-trial-dimitrios-pagourtzis-santa-what-happened-in/10657985/
[6] https://insight.livestories.com/s/v2/mental-health-courts-los-angeles/dfa861fc-6520-4051-b215-9fdf2e62ecca/
[7] Rio Lacanlale, “Nevada will not execute Zane Floyd this month before ketamine supply expires,” Reno Gazette Journal, 14 Feb 2022, https://www.rgj.com/story/news/2022/02/14/nevada-not-execute-zane-floyd-before-ketamine-supply-expires/6785862001/
[8] https://murderpedia.org/male.F/f/floyd-zane.htm
[9] Mark Abadi, James Pasley, Taylor Ardrey, “The 30 deadliest mass shootings in US history include Buffalo and Uvalde,” Yahoo! News, 26 May 2022, https://news.yahoo.com/30-deadliest-mass-shootings-us-184057639.html
[10] https://www.cchrint.org/2022/05/23/mental-health-month-spotlights-failures-more-acts-of-senseless-violence/, citing: https://www.wxxinews.org/local-news/2022-05-18/broome-county-district-attorney-confirms-buffalo-shooting-suspect-talked-about-murder-suicide; https://www.washingtonpost.com/nation/2022/05/15/buffalo-shooting-live-updates/
[11] Annie Sweeney and Stacy St. Clair, “Aurora mass shooter in his own words: ‘I acted out of rage and fear’ in beating of ex-girlfriend with baseball bat,” Chicago Tribune, 19 Feb 2022, https://www.chicagotribune.com/news/breaking/ct-met-aurora-shooting-gary-martin-gun-criminal-record-20190220-story.html
[12] Annie Sweeney and Stacy St. Clair, “Aurora mass shooter in his own words: ‘I acted out of rage and fear’ in beating of ex-girlfriend with baseball bat,” Chicago Tribune, 19 Feb 2022, https://www.chicagotribune.com/news/breaking/ct-met-aurora-shooting-gary-martin-gun-criminal-record-20190220-story.html
[13] Annie Sweeney and Stacy St. Clair, “Aurora mass shooter in his own words: ‘I acted out of rage and fear’ in beating of ex-girlfriend with baseball bat,” Chicago Tribune, 19 Feb 2022, https://www.chicagotribune.com/news/breaking/ct-met-aurora-shooting-gary-martin-gun-criminal-record-20190220-story.html
[14] https://www.the-sun.com/news/4181328/oxford-high-school-shooter-ethan-crumbley/
[15] https://www.cchrint.org/2021/12/06/cchr-urges-investigation-into-failed-behavioral-programs-funding-in-education-increasing-violence/ citing: Corey Williams and Ed White, Associated Press, “Suspect’s parents charged in Michigan school shooting,” News Advocate, 2 Dec. 2021, https://www.manisteenews.com/news/article/Michigan-teen-charged-in-Oxford-High-School-16668023.php; Will McDuffie and Meredith Deliso, “School shooting suspect told counselors alarming drawings were for video game, superintendent says,” ABC News, 4 Dec. 2021, https://abcnews.go.com/US/school-shooting-suspect-told-counselors-alarming-drawings-video/story?id=81559292
[16] https://www.policinginstitute.org/publication/managing-high-risk-adolescents-in-community-contexts-the-averted-paw-paw-high-school-and-south-haven-pier-shooting-in-michigan/
[17] Patrick Reilly, “Accused Santa Fe school shooter still not mentally fit for trial,” New York Post, 11 Feb. 2022, https://nypost.com/2022/02/11/accused-santa-fe-school-shooter-dimitrios-pagourtzis-still-not-mentally-fit-for-trial/
[18] https://www.buzzfeed.com/briannasacks/authorities-were-called-to-alleged-florida-school-shooter?utm_term=.oa47mByJm#.psKga1rXa
[19] “Parkland school shooter’s defense calls witnesses who saw pregnant mother use alcohol, drugs,” Local 10 News, 23 Aug. 2022, https://www.local10.com/news/local/2022/08/22/opening-statements-begin-for-defense-in-parkland-school-shooters-penalty-phase-trial/; “Psychiatrist who treated Cruz says he never received school’s warning letter,” Local 10 News, 26 Aug. 2022, https://www.local10.com/news/local/2022/08/26/psychiatrist-who-treated-cruz-says-he-never-received-schools-letter-warning-of-obsession-with-guns-killing/; Lenny Cohen, “Cruz ‘dreams of killing others’ is ‘not something you wait 3 months for,’ doc testifies,” TND, 25 Aug. 2022, https://thenationaldesk.com/news/americas-news-now/nikolas-cruz-parkland-shooter-defense-sentencing-trial-marjory-stoneman-douglas-high-school-shooting-guns-mental-health-psychiatrist
[20]“Psychiatrist who treated Cruz says he never received school’s warning letter,” Local 10 News, 26 Aug. 2022, https://www.local10.com/news/local/2022/08/26/psychiatrist-who-treated-cruz-says-he-never-received-schools-letter-warning-of-obsession-with-guns-killing/
[21] https://www.cchrint.org/psychiatric-drugs/drug_warnings_on_violence/recent-murdersmurder-suicides/#_edn39. Maria L. La Ganga, “What will Dr. Lynne Fenton say about her former patient James Holmes?” Los Angeles Times, 4 Jun 2015, https://www.latimes.com/nation/la-na-dr-lynne-fenton-james-holmes-20150603-story.html; “Timeline of Events Leading to James Holmes’ Guilty Verdicts,” AP News, 16 Jul 2015, https://apnews.com/article/c6f85ed9e0b14605be3133d407dc204e
[22] “Therapist to mass murderer James Holmes reveals their ‘creepy’ sessions,” New York Post, 27 Aug. 2022, https://nypost.com/2022/08/27/james-holmes-therapist-lynne-fenton-reveals-creepy-sessions/
[23] https://www.amazon.com/Aurora-Psychiatrist-Treated-Theater-Killer-ebook/dp/B09JVFYW4D/ref=sr_1_1?keywords=Aurora%3A+The+Psychiatrist+Who+Treated+the+Movie+Theater+Killer+Tells+Her+Story&qid=1661819319&sr=8-1
[24] https://www.prisonpolicy.org/research/mental_health/
[25] https://calmatters.org/newsletters/whatmatters/2020/01/why-california-is-flush-some-hard-costs-of-mental-illness-and-why-prison-costs-rise-as-inmate-population-falls/
[26] https://www.gao.gov/products/gao-18-182
[27] “California Overmedicates Prisoners with Psychotropic Drugs,” Prison Legal News, 7 Mar. 2016, https://www.prisonlegalnews.org/news/2016/mar/7/california-overmedicates-prisoners-psychotropic-drugs/
[28] https://www.law360.com/articles/1356267/alternative-courts-not-a-catch-all-fix-for-mental-illness-crisis
[29] “California governor’s mental health court plan advances amid worries,” KCRA News, 11 June 2022, https://www.kcra.com/article/ca-governors-mental-health-court-plan-advances/40369801
[30] “A Client Perspective of Mental Health Courts and the Use of Force and Coercion,” http://psychrights.org/Research/Digest/Coercion/PatRisserMHCourtsAndCoercionCompilation.pdf
[31] https://www.cchrint.org/2021/06/11/world-health-organization-new-guidelines-are-vital-to-end-coercive-psychiatric-practices-abuse/
[32] Thomas Szasz, M.D., The Myth of Mental Illness, (Harper & Row, New York, 1974), pp. 267-268.
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