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What can we learn after a homicide committed in a psychotic state?

 A man is arrested after committing homicide on a random victim in a public place. He has been in a psychotic state for a long time. The police say that incidents like this seem to be an increasing societal problem in Norway. The Norwegian Healthcare Investigation Board (Ukom) has found that the picture is more complex. 

Before the homicide, the man had been convicted several times, including for violence and threats. Both the healthcare service and the police had long considered him a dangerous person. Ukom has chosen to call the man Frank. 

More than a year before the homicide, Frank was in pre-trial detention, accused of another serious act of violence. He was psychotic and was therefore transferred to a hospital. The criminal case was dropped, and Frank was discharged from mental health care. 

Our report addresses what happened to Frank in connection with this hospitalization. An important question we have asked ourselves: What weaknesses in the interaction around the very sickest patients prevent us from providing good help? 

Ukom recommends several improvement measures. They are about the possibilities for closer and better interaction between the police and mental health care to safeguard societal protection. There are tools in today's regulations that seem to have been forgotten. These tools will help mental health care have a better opportunity to provide good treatment to mentally ill people with an increased risk of violence. 

When the police become aware of individuals whom they believe need to be hospitalized and who do not seek help on their own, they should request the person to be involuntarily admitted to the hospital. A request for admission gives the police the right to receive information and the right to make statements and complaints related to the admission and discharge of the patient. 

It is unclear what rules apply to patients who are in hospital surrogate custody instead of in ordinary pre-trial detention. This is problematic both for the patient's legal protection and the hospital's opportunities to provide good medical treatment. 

If a patient with psychosis is considered to have an increased risk of violence, mental health care should conduct a systematic violence risk assessment. Healthcare professionals should use information from the police and forensic psychiatric statements as support in their assessments. This can provide better opportunities to design measures that can prevent violence. 

Before this investigation, Ukom reviewed documents from several homicides cases where the perpetrator had a severe mental illness. The report can be useful for the instances that come into contact with individuals who have psychosis and an increased risk of violence. 

The translation from Norwegian to English is based in AI. Ukom has reviewed, edited and quality assured the translation.