The man accused of kidnapping Elizabeth Smart has shown signs of psychosis since middle adolescence, when his family rejected a psychologist's recommendation that he receive treatment for mental illness, a mental health expert said Thursday.

Stephen Golding's testimony came on the second day of hearings to determine whether Brian David Mitchell is mentally competent to stand trial on charges that he and his wife, Wanda Barzee, kidnapped the then-14-year-old at knifepoint in 2002 to keep her as his second wife.

At issue, in part, is whether Mitchell simply holds extreme religious beliefs — that he's a messenger of God meant to take young girls as plural wives — or whether he is clinically delusional.

Both Golding and defense expert Jennifer Skeem have said the homeless street preacher's delusions have intensified to the point where he believes the prosecution is directed by Satan, and he can no longer make decisions based on his own best interest. Mitchell had previously been engaged in plea negotiations with prosecutors, but now refuses to talk to them.

Noel Gardner, a mental health expert for the prosecution, has determined Mitchell is fit to stand trial, but won't be able to take the stand until the hearing continues March 11.

Golding said he believes Mitchell's psychosis began when he was 15 years old. Mitchell threatened his family, exposed himself to neighborhood girls and made a dog test his food because he feared it was poisoned, Golding said.

A psychologist had recommended he be treated at the state hospital for mental illness, but his family rejected the conclusion.

"This isn't about Elizabeth. The origins are in his family," he said.

Third District Judge Judith Atherton said Mitchell's refusal to accept suggestions from his defense attorneys doesn't mean he's mentally disabled, because many defendants make the same decisions.

"The issue is the capacity to engage and the extent of Mr. Mitchell's ability to do that based on his mental illness," she said.

Golding said that for Mitchell, it's not a matter of choice, because he feels divinely inspired and personally responsible for the salvation of the world.

"He now doesn't have rational reasons. He has delusional ones," he said.

Golding also testified Thursday that people with mental illness — instead of simply having strong religious convictions — make life decisions based on "signs" that they see in events around them.

"His world is littered because he's driven," Golding said. "He must discern the signs properly or his soul would be lost."