I've talked to Josh a few times and I think he's a good guy. Last I heard he was going gluten free and able to ween himself off of a few of his meds. Hopefully it's just an imposter or he was drunk. I've seen him go from nice, to issuing what I believe to be real death threats, to apologizing and completely leveling out in his next message.
My wife spent some time working with people in a mental health facility and in my very limited experience, people like this often don't mean the outlandish things they say. I really hope he's doing better. It sucks being born with a screw loose like that because there's often not much you can do but cope. Whatever you do, don't egg him on though. I wouldn't recommend escalating things. Catching him on a bad day could end up pretty ugly.