WEST PALM BEACH, Fla. - Trust is the most important bond between a patient and a physician, especially for those treating mental health patients.
Psychologists say it's not always easy to know for sure if a patient is a harm to themselves or anyone else.
Defense lawyers say James Holmes was a psychiatric patient before he allegedly went on a shooting rampage in a Colorado theater earlier this month.
Locally. defense lawyers of Alexander Petersmarck say he too was a psychiatric patient before threatening to kidnap a Palm Beach woman.
"He did have some help, but it wasn't consistent and because it wasn't consistent," Petersmarck's attorney Michelle Suskauer said. "Because it wasn't consistent that could have led him in the direction he ended up"
Suskauer said last week, Petersmarck hanged himself in a Miami federal detention center.
"Certainly this is a shock," Suskauer said. "Nobody expects or can anticipate this is going to happen."
Wellington Regional Medical Center psychologist Harvey Klein says there is a line patients must cross before they're reported.
"When they pose a danger to themselves or others," Klein said. "That's the specific legal criteria."
But Klein says patients don't always spell out their specific plans to harm themselves or others.
"There are some gray areas with what's the definition of being a danger," Klein said.
He believes Holmes could've been in that same gray area when getting psychiatric help in Colorado.
"I could see a situation where the person treating them obviously knows something is wrong but you can't automatically assume they're dangerous or when the person developed a delusional system," Klein said.
One of the tough decisions a psychologist faces, deciding between keeping what's said confidential and reporting it to law enforcement or someone else.
Investigators say Holmes did send a package with a notebook to his psychiatrist, but what exactly was in the notebook or package hasn't yet been released.
Copyright 2012 Scripps Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Click here to see the latest mugshots in Palm Beach County
Click here to see the latest mugshots in St. Lucie County.
Get the latest updates, photos and video from the devastation in Moore, Okla. Also, see how to help.
Latest Local News Stories
Get the latest news from your neighborhood on our Central Palm Beach County homepage.