Where Hell Is Other Patients

Via NYTimes.com: ‘In the public imagination, forensic mental hospitals — where states place the criminally insane — are hellish scenes of cages and restraints, the better to keep us safe from the Hannibal Lecters of the world.

And it’s true that these hospitals, including the one where I work, are hellish. But not because the patients are restrained. In fact, it’s the opposite. Patients, even violent ones, are often given a shocking amount of freedom. As a consequence, every day, across the country, these hospitals record dozens of assaults by patients against staff members and other patients — a situation that, thanks to expanded patients’ rights laws and state health bureaucracies, we can do almost nothing about…

To be clear, not all, or even a majority, of patients are actively violent. Just 15 percent of patients at most hospitals are responsible for 90 percent of the assaults. And yet at almost every state forensic facility I have encountered, there is an epidemic of assaults by violent patients.How have things come to this? After the deinstitutionalization movement of the 1960s and the introduction of effective antipsychotic medications, most hospitals were emptied of “regular” — largely nonviolent — mentally ill patients; those vacancies were filled by the growing number of people who were successfully pleading not guilty for reason of insanity.

But state hospitals are ill-prepared to deal with these often dangerous and violent persons. A large part of the problem stems from our legal system, where the notion of patients’ rights has triumphed over common sense and safety. For example, despite criminally insane patients being remanded by the courts for psychiatric treatment, many states allow them to refuse both therapy and medication.

A second difficulty is bad hospital policy: At many state forensic facilities, there are no guards, and untreated psychotic patients are allowed to mix freely with the staff. Perhaps because the extent of violence in forensic hospitals is difficult to imagine, it’s easier for hospital administrations, elected state officials and governors to ignore.

Still harder to explain is the silence of mental health activist and regulatory groups — the American Civil Liberties Union, the Occupational Safety and Health Administration and the National Alliance on Mental Illness. Generally at the forefront of worker and patient safety issues, these organizations have inexplicably done very little…’