Results indicated that during the study period there were 88 people charged with 93 homicide offenses committed during an acute phase of mental illness. The greatest risk of violence leading to homicide occurred during the early phase of the illness, most commonly during the first acute psychotic episode. Auditory hallucinations and delusional beliefs concerning personal danger were the symptoms that were most significantly related to lethal assault. Most victims were family members or close associates and only 9 of the 93 victims were strangers. A high rate of drug misuse was also uncovered and included mainly drugs known to induce episodes of mental illness. The findings suggest that any sudden changes in mental state, delusional beliefs, or threatened or actual violence should be met with immediate mental health intervention. Most importantly, the first psychotic episode should be treated as a psychiatric emergency. Data were drawn from the court files of 93 mentally ill offenders charged with homicide who were identified by a psychiatrist for the Corrections Health Service. The court files included psychiatric reports, demographic information, early childhood development, educational and occupational attainment, personality traits, criminal history, history of brain injury, substance misuse, circumstances of the offense, and prior mental health contact. The primary variables under examination were the demographic and clinical characteristics of the perpetrators and the estimated frequency of homicide during psychotic illness. Descriptive statistics were used to analyze the data. Tables, references