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Prosecution of violent patients

  • Laurence Tuddenham (a1) and Robert Hunter (a2)
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Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Bayney, R. & Ikkos, G. (2003) Managing criminal acts on the psychiatric ward: understanding the police view. Advances in Psychiatric Treatment, 9, 359367.
Eastman, N. & Mullins, M. (1999) Prosecuting the mentally disordered. Journal of Forensic Psychiatry, 10, 497501.
Home Office (1990) Provision for Mentally Disordered Offenders (Circular 66/90). London: HMSO.
National Audit Office (2003) A Safer Place to Work: Improving the Management of Health and Safety Risks to Staff in NHS Trusts. http://www.nao.org.uk/publications/nao_reports/02-03/0203623.pdf
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Prosecution of violent patients

  • Laurence Tuddenham (a1) and Robert Hunter (a2)
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eLetters

Psychiatrists should not decide...

Thomas Marshall, LD Psychiatrist
28 July 2005

I am writing in response to the authors response to my intial letter.I am well aware how unhelpful the police and CPS can be in these matters. However, my view is that I would prefer the police or CPS decline to proceed than not to have reported the incident at all. The fact that the authorities do nothing is no reason to suggest that they should not be informed. Not to inform them lets them off the hook if there is a disasterlater down the line.

I suspect that Trusts should have a policy around assaults on staff that states the police should be informed as a matter of course. Thus, victims do not feel frightened to press charges or guilty about doing so. My experience is that staff feel that they are not entilted to the same protection under the law as everyone else. The only hospital I worked at where assaults were regularly reported to the police was Rampton.

If a patient seriously assaults staff, then the Consultant involved should inform the police irrespective of the victims wishes. In law, one cannot consent to being assaulted. A forensic order with or without restriction identifies the risk and provides a statutory framework for managing it. A restriction order may state that the patient must take a depot on discharge, must provide urine for drug screening and must cooperate with supervision. If they do not they can be recalled to hospital by the Home Office irrespective of their mental state.
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Conflict of interest: None Declared

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Re: Psychiatrists should not decide whether to involve the Police

Laurence M Tuddenham, Specialist Registrar in Psychiatry
21 July 2005

We agree with Marshall that psychiatrists should not decide whether to report potentially criminal acts to the police, not least because of the difficulties in maintaining a therapeutic relationship that this may cause. Marshall has criticised us for deciding whether to report an assault to the police. Our original letter noted that in two cases the victims decided not to report the assaults. In the other case, the victimreported the incident, and only then did we write to the procurator fiscal. This point is perhaps not clear in our letter. We took this unusual step because it appeared that similar charges against the patient had been dropped simply as a result of his admission to a psychiatric hospital, and the patient showed a pattern of increasingly aggressive behaviour specifically targeted towards staff in contact with him.

The victim's attitude to reporting an incident appears to have the most bearing on whether attacks are reported - including potentially serious attacks. In these difficult cases, we have suggested that an independent person could make the decision after discussion with the relevant staff.

Finally, we must be practical - if public prosecutors are unwilling to proceed even the case of someone we judge not to be mentally ill, how can we expect them to do something in the case of a floridly unwell patient?
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Mental illness is no excuse for violence

Gertrude Jones, On a career break at the moment
14 July 2005

I haven't read the whole atricle, only the response above. In my opinion having gone through psychosis and severe mental illness, I don't think anyone should hesitate in reporting a violent attack by a mentally ill person.Firstly, it is in the patient's best interest to receive support and help to deal with their aggression. Secondly, no-one should have to deal with violence at work. Thirdly, if it goes unreported and then another assault is committed then who's accountable? And lastly, i'm fed up of people thinking all mentally ill people are violent, because we are not. ... More

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Psychiatrists should not decide whether to involve the Police

Thomas Marshall, LD Psychiatrist
14 July 2005

The authors seem to feel they have the authority to decide whether anassault is reported to the Police. My understanding is that all citizens have the duty to report criminal acts to the Police. Of the examples givenby the authors, the most serious was not reported to the Police even though it could potentially have resulted in the death of a member of staff had circumstances been different.

Prosecution allows a range of further options over and above those available through the civil acts. A patient who when ill has the potentialto seriously injure or kill a member of staff can be more safely managed on a restriction order. If that patient who was not prosecuted goes on to commit a serious offence in the future, those who failed to inform the Police would have to justify their decision.

We should not make moral judgements about our patients and their motives for violent assault, but be guided by the fact that criminal acts should be reported to the Police. It is then the decision of the Police and CPS or equivalent to decide whether it is in the public interest to proceed. It is at this stage that we should express our professional opinion to try and guide them.

My own view is that I urge the victims of assault to inform the Police and support them if they do so.Failure to inform the Police means services accept responsibility for the future risk that person poses to others.

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