Legal implications of the increased risk of homicide and serious violence in the first episode of psychotic illness

There is emerging evidence of a greatly increased risk of homicide, serious violence and suicide during the first episode of psychosis (FEP), which increases if there is a long duration of untreated psychosis. The period before the emergence of frank psychotic illness (the prodrome) has also been shown to be a period of increased risk. The finding of increased danger associated with the FEP has implications for civil, criminal and mental health law. In civil law, it could affect the assessment of the standard of care provided and the perceived duty to warn the patient’s close associates. In criminal law, first episode patients may be considered to have a lower level of criminal responsibility, including during the prodrome of illness. The FEP is now known to be a psychiatric emergency for which there should be a lower threshold for involuntary treatment.