Thursday, October 19, 2006

Fully Charged Battery

As Dinah once said early on in the Shrink Rap blog days, "I'm Concerned About Fat Doctor". Yesterday FD wrote a post about an angry, drunk former patient who showed up at her clinic and threatened to kill them all. This is not a good thing. The police responded, tracked the guy down and warned him away. While lots of comments offered support, I was left feeling a bit dissatisfied and disconcerted. Hopefully Angry Drunk will not return to the clinic, but even so it seems to me that he has successfully avoided any consequences for threatening to kill many people. It left me with the question that I'm going to post to the blog, although without a poll this time:

Should you press criminal charges against your patients?

This is a policy question that inpatient units wrangle with on a regular basis. It comes up most often on forensic units but it can also be an issue on general medical wards. When I was in training (back in the Days Of The Giants) our admission agreement, signed by all new admissions, stated that anyone found in possession of contraband (ie drugs) would be discharged. I didn't think too much of it at the time, but years later I thought it interesting that there was no mention of automatic criminal charges. To me that was like telling the patient, "We won't treat you but if you promise to leave quietly we won't call the police." When the stakes are higher and the behavior is more serious, the situation gets trickier. What if your inpatient beats up a nurse? This is dicey---sick people sometimes do sick things, that's why they're in the hospital---but sometimes not-so-sick people do sick things too simply because they're angry.

The decision to charge-or-not-charge is not an easy one. Off the top of my head I don't know of any hospital that has an automatic prosecution policy for assaultive patients. Usually the decision is left to the victim with or without the explicit support of hospital administration. Fortunately in correctional facilities there is a well defined process with consequences for behavior like this. Unfortunately for free society, it can be an uphill battle to pursue charges when the prosecutors themselves are reluctant to take cases involving inpatients.

On the "con" side of the argument (pun intended) there are those who state that prosecuting patients serves to punish people at the very time they are seeking help. Prosecution undermines the safe-for-the-patient atmosphere that is necessary for successful therapy and it further criminalizes the mentally ill. The most extreme anti-prosecution argument I've seen suggested that going to the police was itself a violation of confidentiality.

So there you have it. Let's hear it. And for the record, an assault or threat in my facility could get you 30 days in segregation.