Pressing charges against patients under treatment: Criminalization can begin in the hospital ward.

Families are naive and uninitiated in the harsh realities that lie in wait for loved ones who have a severe mental illness diagnosis.  Families and supporters may believe that once their loved one is admitted to a hospital for treatment, that this is a time of respite, a time when the daily stress, anxiety, and trauma of caring for someone with a psychotic disorder is put into suspense.  Little do the uninitiated know that once their loved one is admitted to a hospital for treatment, perhaps under the dangerous standard required under most state codes, that the threat of criminalization is not put into suspense.  Families and supporters may not realize that if their loved one becomes (symptomatically) assaultive toward another patient, toward hospital staff or toward a member of the security team at a hospital or other institution, that charges may be pressed and that their loved one can be jettisoned into the criminal justice system. Pursuing prosecution of a person who is under treatment under these conditions is criminalizing symptomatic behaviors and imposing strict criminal liability upon the accused.  Placing someone in this class into the due processes of a criminal justice that operates on a presumption of sanity (sadly, with literality) is immoral and abusive.

This epidemic has been promoted by a pernicious dissociation of symptomatic assaultiveness from the medical conditions that cause it.  There are multiple principle factors that have played a role in this dissociation.  The following are just a few of them.

*Activists against stigma have been weak advocates for the subset of people with psychotic brain disorders who are at risk for assaultiveness.  The anti-stigma movement promotes the mantra that the mentally ill are ‘more likely to be victims of violence than perpetrators’.  It does not help the cause of this activism to wrap around and defend the subset of the most seriously ill who may become symptomatically assaultive.  Anosognosia, clinical-level delusions, disease severity and other factors characterize people at high risk, however, anyone with a psychotic disorder who is untreated, refractory to treatment, in relapse, or otherwise vulnerable is at risk for self-harm or harm to others.


*Nursing associations who in some states have pushed for assault upon a medical professional or allied health associate to be charged as a felony.  People who work in medical institutions rightfully and understandably want to be as safe and secure as possible even when working with a patient population with known risks.  The problem is that they are transferring the responsibility to the patient for accountability.  They will not take action against their employers for not creating safer working environments.  The “frenemies”, i.e. the disability rights and advocacy community in some ways has contributed to the problem of managing very sick and symptomatically assaultive patients for challenging ward management policies governing application of certain carefully monitored restraints upon assaultive patients.  In many cases, community and even state hospital systems are not structured to effectively deal with the realities of managing assaultive patients.  The community, the institution, the state does not have to answer for these deficiencies.  All the burden, the responsibility, and the penalties are transferred to the patient or resident of the institution.

*The criminal justice system (with its operants who understand so little about psychosis and who might be disposed toward rejecting the implications of the neuroscience of psychosis-driven assaultiveness if the science impedes the march toward retribution and punishment) would deny that strict criminal liability is being applied.  Their denials and assertions that support prosecution and punishment are too often aided by a forensic psychiatry contingent that has sold itself to the criminal justice apparatus.  Certain operants within the criminal justice system have pressured hospital administrations to press charges against patients under their care.

DueJusticeProject’s position is that administrative procedures need to be put into place to assess and adjudicate in the case of these assaults that do not serve to criminalize the symptomatic behavior of very sick patients under treatment or medical management.  Patients should not be prosecuted and punished for the consequences of poor ward management, deficient facility dynamics and infrastructure, poor staff training, and other critical factors.  People who work with this patient population, including security staff should be provided comprehensive education to impart knowledge and comprehsion of psychotic disorders and the behavioral aspects of the disorders.