When mental illness leads to violence: A legal and medical dilemma

On May 1, a woman fatally stabbed a 3-year-old girl who was walking with her mother at Denov market. Almost three weeks later, on May 19, a man stabbed a patrol officer at Yunusabad market. The officer received emergency medical assistance and survived.

There is one significant commonality between both perpetrators: they were registered at a mental health clinic.

These incidents have sparked public concern and raised questions such as: “How can mentally ill people walk freely?”, “What measures are being taken against them?”, and “Are there so many dangerous individuals on the streets?” Experts have weighed in, and this article explores their insights alongside relevant legal perspectives.

Psychiatrist Zebiniso Ahmedova told QALAMPIR.UZ that a person with a mental illness does not automatically become a criminal. However, certain psychiatric disorders can increase the risk of criminal behavior.

For example:

 In antisocial personality disorder (sociopathy or psychopathy), individuals may commit serious and premeditated crimes, often violating laws and social norms.
- In paranoid schizophrenia or psychosis accompanied by violent hallucinations, there is a higher risk of serious crimes such as murder or assault, often under the influence of command hallucinations.
- During the manic phase of bipolar affective disorder, aggressive and uncontrollable actions, including violence, may occur.
- In dissociative disorders (commonly referred to as split personality), the individual may commit crimes as a result of a fractured mental state.

In such cases, compulsory treatment can be prescribed if the individual is deemed a danger to themselves or others, cannot control their actions, and if a medical commission confirms this condition.

“If a person with a mental illness is fully in control, takes prescribed medication regularly, does not pose a danger to others, maintains stable behavior, and is under the supervision of a psychiatrist, then they are permitted to walk freely,” said Dr. Ahmedova.

She also emphasized the difference between psychopathy and sociopathy. Psychopathy is often hereditary. Psychopaths lack empathy or compassion, believe they are always right, and seek to dominate others. Sociopathy, on the other hand, is usually acquired through life experiences, such as severe domestic violence, and is characterized by cruelty, hatred, and social alienation.

According to Ahmedova, most psychopaths and sociopaths commit crimes due to their inability to control themselves. Psychopaths tend to act systematically, while sociopaths often act impulsively.

“Although both suffer from mental disorders, they may still be held criminally responsible. If a forensic psychiatric evaluation finds that the person was aware of their actions at the time of the crime, they can be held accountable,” she explained.

What does the law say?

In Uzbekistan, mentally ill individuals who commit crimes are not prosecuted under general criminal law, but under a specific procedure governed by the Criminal Code, the Criminal Procedure Code, and the Law “On Psychiatric Assistance.”

Article 18 of the Criminal Code states that individuals who were mentally ill at the time of committing a socially dangerous act—meaning they could not understand or control their actions due to a mental disorder—are not held criminally liable.

However, the law allows courts to impose medical coercive measures in such cases.

Article 181 stipulates that a person who was partially aware of their actions due to a mental disorder may still be held criminally liable.

According to Article 8 of the Law “On Psychiatric Assistance,” people with mental disorders enjoy the same rights and freedoms as all other citizens under the Constitution and national laws. Article 16 of this law mandates that compulsory treatment can only be applied by court order. Article 30 outlines the conditions for psychiatric hospitalization, which include a medical diagnosis and a psychiatrist’s recommendation or a court decision.

Article 31 allows for emergency psychiatric hospitalization without a court order in cases where an individual poses an immediate threat to themselves or others.

These laws attempt to balance public safety with the rights and dignity of individuals suffering from mental illness. As incidents involving mentally ill perpetrators raise concern, experts and lawmakers continue to navigate this complex intersection of psychiatry, law, and social protection.

One in eight people worldwide suffers from mental illness

According to the World Health Organization, one in every eight people—approximately 970 million individuals—were living with a mental illness globally in 2019. This number rose significantly in 2020, largely due to the effects of the COVID-19 pandemic. Initial studies showed that anxiety disorders increased by 26 percent in just one year, while major depression rose by 28 percent.

In 2019, the global mental health landscape included the following:

- 301 million people were living with anxiety disorders, which are characterized by persistent fear and behavioral disturbances.
- 280 million people suffered from long-term emotional depression.
- 40 million people experienced antisocial behavior disorders, marked by actions that defy societal norms, infringe on the rights of others, or break legal boundaries.
- 40 million people were diagnosed with bipolar disorder, a condition that causes extreme mood swings between depressive lows and manic highs.

Additionally, around 24 million people worldwide were affected by schizophrenia—a severe psychiatric disorder involving profound distortions in perception, thinking, and behavior. This means roughly one in every 300 people has the condition. Life expectancy for individuals with schizophrenia is 10 to 20 years shorter than that of the general population.

Research in this area reveals a striking paradox. While some mentally ill individuals have committed serious crimes, they are far more often the victims rather than the perpetrators. A genetic predisposition, combined with external rejection and discrimination, can severely affect the mental state of these individuals. Furthermore, a series of tragic incidents underscores the urgent need for a shift in how mental illness is addressed—both medically and socially.

Rather than focusing solely on punitive or restrictive measures, experts are increasingly calling for comprehensive mental health support, better integration into communities, and reforms that protect both the rights and safety of those affected. The rising statistics and social consequences suggest that it is time to adopt a more humane and proactive approach to mental health care worldwide