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When Violence Strikes on a Psychiatric Ward

Milwaukee County’s Mental Health Complex features a short-term inpatient psychiatric facility that seeks to help those with serious mental health issues — including survivors of trauma and sexual abuse — get better. Patients stay an average of 11.5 days while at the facility and more than 90 percent of them are discharged back to their own care or home.

By far, most people who are admitted to the facility carry a diagnosis within the “psychoses” category of diagnoses — which usually means schizophrenia or a related disorder. Over one-third of their patients are under 19 years old — teens and children. About half the patients they treat are men, the other half women.

More than half the people who seek out treatment at a facility like this will have their tab picked up by taxpayers like you and I, because their bill will be paid by Medicare or Medicaid.

The Complex sports four inpatient wards. But the Complex has a bit of a problem. Instead of segregating men from women on the wards — which is common practice in many other inpatient psychiatric facilities — Milwaukee County has co-ed wards. Normally, this wouldn’t be a problem. If this were a college. But it’s not a college, it’s an acute inpatient treatment facility.

So when violence strikes the wards, what do they do?

23 Comments to
When Violence Strikes on a Psychiatric Ward

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  1. A similar tragic story happened in Toronto, where a severely ill woman was detained in a forensic psych ward as the only female among 19 male patients. She was raped, had a child who was severely brain damaged to due the medication she was on, and the whole mess led to a major lawsuit only recently settled.


  2. I would like to say something here, as I am currently working on an inpatient unit, and frankly, I am very tired and disappointed that people not only tolerate violence, but want to excuse it. You won’t get through to violent people, especially if it is NOT due to true Axis 1 diagnoses, and, that is why we have prisons these days, as they are staffed by mental health personnel, and so we cannot control the forensic population that is literally innundating psychiatric units under the misguided and clueless intentions of judges and lawyers looking to pass the problem somewhere else.

    No, you have to have a zero tolerance policy about violence, between patients especially, not that I am tolerating violence on staff, but, we have more control and ability to set limits than patients do. Psych units should be sanctuaries, so people can heal. And if someone cannot be redirected and motivated to find other more responsible and productive ways to deal with frustration, intolerance, and downright antisocial ways, then, that is why we have cells and secure environments that can seclude and isolate.

    This is not insensitivity, this is the reality of mental health inpatient care as of 2010. And those who will argue otherwise are not working on the units. Count on it!

  3. Oh, they do this in my state, too. They’ll put convicted sex offenders in with patients who are victims of sexual assualt and who haven’t committed any crime. I was inpatient in a county hospital for major depression. I’ve never committed a crime of any sort, and I was put in with people who had a history of sex crimes. It was a co-ed facility but I was the only female there that night. I was terrified. I asked if there were any patients there who were convicted sex offenders, and I was told they could not answer that, but that it would be a good idea if I stayed near a staff member when I was in the common areas. They pretty much answered my question.

    I asked if they would lock me in my room that night and they said they couldn’t do that. So, I pleaded with them to lock me in the quiet room (or whatever it’s called), and they wouldn’t do that either. I didn’t sleep at all. I had a male patient ask if I would perform a sexual act on him. I told the psychiatrist when he came by the next morning that I was in an unsafe environment and either let me go, or let me speak to an attorney. I made it very clear that if I were assaulted by a patient after having expressed my concerns about my safety to them, I would sue them. It was unsafe, and they knew it. If they’re going to force patients to stay involuntarily, then they darn well better protect them from other patients or let them go. He signed my discharge papers within about 5 minutes. You don’t help anyone with depression by putting them in a facility with patients who have committed sex crimes. That should be a no brainer.

  4. Dr. Hasselman, I really appreciate reading your perspective. I guess I didn’t realize the psychiatrist didn’t have a choice but to take sex offenders. Maybe the psychiatrist felt the same way you do, and wasn’t excited about getting them either. If they’re going to admit people with a history of sex offenses and other violent crimes then they’ve got to put them in a separate ward. I had no way to protect myself if that patient had decided to assault me. I was like a sitting duck. I couldn’t run anywhere and lock a door. It was a very helpless feeling. The staff couldn’t be there 100% of the time, and it doesn’t take long for something to happen. I left the hospital more depressed and with a whole lot more anxiety than I went in with.

    I also think that putting people who have a history of committing violent crimes in with those who haven’t reinforces the prison like environment. The staff treated patients like prisoners instead of patients, which now it makes sense, because some of them have done some pretty terrible things. The problem is, the rest of us hadn’t.

    I like your idea of the hospital being a place of healing and a sanctuary. It’s definitely not a sanctuary if patients are having to worry about being sexually assualted.

  5. I couldn’t agree more with everything you said Joel…

    I am shocked and downright outraged that violence and sexual assault goes on in psychiatric units of a hospital. Hospitals are places where patients are supposed to feel safe and cared for, not a place where they have to look out and fear for their own life. I literally had to pick my jaw off from the floor after having read this. If a staff member has the slightest inkling that patient might be a danger to him or herself/others then that’s it…solitary confinement until they can get better control over themselves. Psychotic or not violence ESPECIALLY SEXUAL ASSAULT should not be tolerated..I don’t care if the patient is “out of their mind” due to psychosis it is inexcusable. If it happens then they should be prosecuted to the fullest extent of the law. Just because you are mentally ill doesn’t give you the right to endanger in welfare of another human being(and I am talking outside of the hospital environment)!

    I am seriously disgusted that this kind of stuff goes down in the psych units where patients come to get better, heal and feel safe. Being violated by another patient is seriously atrocious and like Joel said…shows sings of being anti-social and if you know a thing or two about mental heath disorders you know how these anti-social patients don’t have a good prognosis…not only that after their stint in the hospital..most of them wind up incarcerated anyway…where they belong in the first place.

  6. Great insight there Dr. Hassman — we wouldn’t tolerate such violence in any other facet of our society (our schools, our malls, our workplaces), why would we ever tolerate it in our hospitals??!

    Finally, 3 supervisors of the Milwaukee County board are calling for John Chianelli’s firing:

  7. Kylie, I definitely agree with you. I think the problem, though, is that many mental health professionals don’t see it that way. Most of the time, people get admitted to psych wards for being considered a risk to themselves or others and they lump them all together, and then people are surprised when a patient is assaulted. I think they ought to put those who are at risk of harming themselves on one unit and those hospitalized for being a danger to others on a different unit with no interaction between the two. The last thing someone who is depressed needs is to have to worry about someone assaulting them. That’s how many people end up depressed and suicidal to begin with.

  8. I think they should lock Mr. Chianelli into the facility overnight and see if he changes his mind….

  9. From the Journal Sentinel Editorial Board May 12:
    “Supervisor Patricia Jursik, who was at a meeting with Chianelli last month and emphasizes that the complex does have problems, disagrees with the other supervisors’ reporting of his remarks. She told us that Chianelli’s comments were taken out of context and juxtaposed in a way to change his meaning and to hurt his reputation.”

    This story is based on hearsay from a politician (who will be running for re-election in the fall), reporting her recollection of what was said 6 weeks earlier at a closed meeting, violating not only the confidentialy of the meeting, but also the reputation of this poor man who apparantly is prohibited from commenting. Despicable.

  10. I totally agree with you Joel. Psychiatric hospitals and inpatient/outpatient clinics are to be sanctuaries for those to heal, not assault each other. More control needs to be implemented within these clinics and also convalescent homes. Because of the emotional, psychological, and behavioral problems often found with such patients, it is important that staff take control and assure that each patient/client can receive the best services and environment possible.

    What if a situation like this one includes children or adolescents? Will society take this thing more seriously then? Probably so.
    If violence became a central issue within child and adolescent psychiatric centers (inpatient and outpatient) or hospitals, staff would probably be more vigilant in assuring patient safety, at least I would hope so.

    I’m glad firing John Chianelli is being considered. People who believe as Chianelli does doesn’t help us progress in the field of psychology and mental health treatment at all. It also doesn’t help assure families that their loved ones are being taken care of within these clinics. He is not good for our level of legitimacy as mental health professionals.

  11. “About half the patients they treat are men, the other half women.” How estute, DocJohn (just teasing). 😉

  12. Oops….Astute.

    I’ve been on many psych wards and have never witnessed another patient attack anyone but have seen many do themselves in. Why is it so hard to ID the really dangerous ones, especially those with tendencies towards sexual aggression? All of the wards I’ve been on were coed, as well. Perhaps I’ve simply been lucky because those who were dangerous were isolated.

  13. I’ve been hospitalized in many psych wards, all of them co-ed. Two incidents stand out for me.

    One night I woke up in my curtained-off ward bed to find a male patient hovering over me half-naked. I screamed and ran to the nurse’s station. A nurse told him to go back to bed, then told me to do the same. I couldn’t sleep the rest of the night, terrified. I’m a sex assault survivor! I went back to the nurse a couple of times but instead of being sympathetic or giving me something to help sleep, I was scolded for not staying in bed and not sleeping. Nothing was ever done. I begged my doctor to discharge me.

    Another time there was a co-patient who was manic, irritable and disinhibited. She kept kickboxing other patients in the face, unprovoked (maybe in her mind she was provoked, but some of her victims never even spoke to her). After each attack the nurses would put her in seclusion but always let her out again after a short time. Then she’d kick someone else in the face. It went on and on.

    Segregating violent people makes sense.

  14. It is unfortunate to read in the Wed May 12 edition of USA TODAY the article “Mentally Ill are sent to jail more than Hospital” and read the quote from Summit County Sheriff Drew Alexander re the increase in psychiatric incarcerations, with his logic of threatening to stop accepting VIOLENT mentally ill people at that county jail:

    “We don’t want to be a dumping ground.” No, let’s do it to ill equipped psychiatric units for these VIOLENT patients who cannot be adequately secluded and restrained, thanks to the pathetically organized changes in restraining and controlling violently inclined people, psychiatric or characterological, or just plain antisocial/sociopathic and looking to hide behind false pretenses of psychiatric diagnoses to escape legitimate charges.

    You have to love this logic, having dealt with it first hand recently: sent a hostile, noncompliant person from a jail to a psych unit under the guise the patient will be “treated better”, only to watch the patient completely disrupt the milieu and treatment for the other patients there, while the jail has a psychiatrist and access to prn meds. It is bad enough people who are not psychiatrically sophisticated think that psychiatric hospitals still operate under the 1970’s rules and infrastructure that is not in place as of 2010. Not that those environments decades ago were so wonderful and effective. But, for psychiatrists and others with some mental health awareness to cluelessly think that psychiatric hospitals can strait jacket people, chemically restrain with 500mg of thorazine, and just restrain them in quiet rooms for days is just absurd to have to listen to.

    Again, that is why we have jails, and why the courts will assess if someone is not criminally responsible, it should be done in the legal system and protect those who are not legally bound for such assessments and determinations. This blurring of the boundaries between law and health care is beyond concerning. Forensic Psychiatry is not helping care, in my opinion. It is just complicating it.

    You cannot overlap the black and white expectations of the law into the grayness of mental health care. Oh well, we’ll just have to watch more incidents prove me wrong, or, right.

  15. Joel:

    The blurring of the boundaries between law and health care is indeed concerning and quite disturbing. But I’m looking at things from a different angle than you are, I think. Correct me if I’m wrong but you think the jail system should deal with violent individiduals (despite the presence of psychiatric illness), and not the mental health system where other patients are put in jeoporady. I do agree other patients are put in extreme jeoporady when violently and psychiatrically unstable individuals are placed in the same areana as nonviolent patients. But I don’t agree the jail system should handle this and I’m afraid the answer to helping criminally and mentally disturbed individuals is not easy and clear cut. If it were, the forensic system would have better assessment measures, better measures of assessing for malingering, and better ways of understanding the criminally insane. We have a problem because we tend to “criminalize” and jail the unstable who exhibits criminal behavior. Jail is not necessarily the answer.

    While “criminals” do criminal things, many are mentally unstable and often led by their unstable minds. These individuals are often put into jail cells while they should be put into mental health hospitals. I have come to see that there are three different types of individuals: those suffering from mental health problems who are not violent, those suffering from mental health problems who are very violent, and those suffering from mental illnesses who are strictly criminalistic. But should the “criminal-type” be put into jail to spare the nonviolent mentally disturbed patient?

    Perhaps…but that doesn’t remedy the delimma at all. Because of our jail system, the mental health system has been negatively affected by criminalizing the mentally ill and we must de-criminalize mental illness. Although the threat is very real for nonviolent patients when in the same vacinity as criminal mental patients, a simple solution including segregating patients by putting some in jails and others in psych-wards is like putting a blanket over a fire and hoping that the fire goes away.

    We just have such a big delimma and I’m afraid it is not as simplified as segregating the mentally ill and the criminally ill.

    I am all for protecting the rights and health of nonviolent patients, but we cannot overlook the violently insane and mentally unstable. We must see them as victims as well, because they are living in a mind that they cannot always control. You must agree that not all “criminal behavior” is criminal. Sure, there are sociopaths, manipulators, and evil intent, but there are also those who are “criminal” but are also VICTIMS of their criminal behavior as a result of their unstable mind. We must remember that Mens rea (i.e. a guilty mind”) is not always present in criminal cases involving psychiatric patients.

    It is indeed quite challenging, but there has to be a better way of handling such mind-boggling situations. We need to protect and we also need to de-criminalize when necessary. If there isn’t a better way of dealing with such issues, we have to find a middle ground and it shouldn’t be black and white.

  16. Let me just say this, as I had written a more lengthy piece that my damn servor cut me off before submitting, but I’ll summarize it hopefully more succinctly:

    Sometimes, once is too much! Before you advocate further that the system cannot be changed to any appreciable degree for the better, remember that adage if you talk to a person who signed in on a voluntary basis for inpatient care who was then assaulted by a forensic patient who had no interest in legitimate assessment and treatment opportunities.

    Not all admissions to psych units are on a certified basis. I think a sizeable portion of psychiatrists, especially forensic ones, seem to forget that when trying to pacify judges that their clients(and that is not a typo, as to the forensic doc that is who they are working for, not treating) are better served assessed and treated in non-correctional environments. Well, you are right that those who are jailed for what really amount to petty crimes are not best served staying in jail, but why do most correctional facilities have a mental health care staff in the medical departments these days? They are trying to account for it, but, they don’t like treating the violent people, do they? And what healthy doctor instinctively does?

    And that is why we have facilities like here in Maryland that is Clifton T Perkins. Yet not every one who needs to be there can be placed. So, we have to let non secure psych inpatient units be substitutes? Forensic Psychiatry either is a subspecialty of psychiatry but still embraces the basic tenet of medicine, that being responsible advocacy, or, it is an agent of the court, and should stay in that system! Hey, that is the black and white thinking of law! You can’t have it both ways, right?

  17. There should be separate wards for men and women, violent and non-violent. What a person who’s severely depressed needs is to feel safe enough to get better and not have to worry about being raped or attacked by a violent psychopath who just happens to have some mental health problems as well.

    I have been so severely depressed that hospitalization was considered. I am so glad I didn’t do it, I definitely wasn’t aware that violence is a concern. After all, everyone says “hospitalization” is to keep you safe.

    Is there anyway you can find out what the practices are at the psych wards in hospitals where you live? Are private hospitals much better?

  18. TH writes, “But should the “criminal-type” be put into jail to spare the nonviolent mentally disturbed patient?”

    I think the answer is yes. If you admit women to a facility with a person(s) who has a known h/o of violence against others, then you are responsible when patients are assaulted and/or live in fear while they’re there. Believe me, when you’re the patient that’s being threatened and you can’t defend or protect yourself, then you would likely see things much differently. I see this as no different than saying yes, he’s a pedophile but he has a mental illness so we’ll put him in a facility and let him be around children and then we’ll all act surprised when something happens. If a person has committed a violent crime because of their mental illness then put them in a separate facility away from those of us who haven’t. I would add that it’s also unfair to the men who have done nothing wrong. Who wants to be the roommate of someone like that?

  19. Lynn, I would say before you ever consider going inpatient that you really, really do your homework. I’ve been in 3 separate facilities and they were all bad. They were co-ed, and of course most of the men were fine but a couple of them weren’t. It only takes one. With the county hospital I was hospitalized in I was forced to strip in front of a staff member (a very helpful thing to do with people who have been sexually assaulted, by the way), but the other 2 hospitals didn’t do that. Then, they go through your things. In one of the hospitals, a male staff member held up my underwear in front of other patients as he was going through my things and told me how nice my underwear was. Just what I needed. One of my roommates had Alzheimer’s disease and she literally stood by my bed peering down at me while I tried to sleep. Not exactly helpful to my own sanity.

    I basically sat on my butt all day, every day. The only sunshine was during a smoke break (I didn’t smoke) and they even threatened to take that away from people if they didn’t go to group. The groups were a joke. I listened to a psychotic patient go on an on about fabricated events and everyone had to sit there and listen to it, and of course pay for it. The food was dripping in grease, it was like concession stand type food, not healthy at all. They refused to let one woman mail a letter which is illegal, but they did because they could. It was like a prison only with a big bill at the end. I would have been better off if I had poured that amount of money into a spa vacation.

    I left AMA in each instance (I’m a slow learner – I let myself get talked into it each time being promised it would be a better hospital but it wasn’t), and leaving was the absolute right thing to do. It wasn’t remotely helpful to me, and in fact, I found it to be a very dysfunctional environment. My issue was also depression and I needed the things that help depression like sunlight, exercise, comfort/support rather than a punitive environment, safety, healthy food, etc. My experience is that the psych hospital was the exact opposite of all the things I needed to get well.

    Obviously, others have had more positive experiences. Perhaps psych hospitals are better in other states and maybe others are better in my state I don’t know, I can only speak to my own experience. Whatever you do, though, learn your rights and know them well, and research the hospital. Even though I was a “voluntary” patient, they don’t make it easy for you to leave once you sign on the line (unless your insurance runs out). If you get in and decide it’s not helpful, be prepared to fight if you want to get out before they decide you’re ready.

  20. Joel, its convoluted and I’m lost for words. But I can say this, jailing the mentally unstable because they are violent will not only fail that individual, but their families too. We should “study” them, not throw them away, help them, not ignore them.

    I also feel responsible for those in-patients (especially children and adolescents) who must deal with violent in-patients because we cannot figure out how to protect the innocent. It is very disturbing that an innocent patient must deal with violence while they are trying to “heal” and adjust. It is indeed a serious problem. But again, jailing them is not the answer because we must also look at the fact that the criminally “insane” or disturbed are too battling a mental illness. Should we criminalize them or work with them somehow?

    Anon, interesting point. But I respectfully disagree. I think the point here is to not place mentally unstable and criminal patients into jails, but to place them in facilities that will treat their problem(s).
    Of course we do not want to jeopardize other’s well-being, but we don’t want to “throw” away those who are difficult to comprehend and treat. The difficulty in appropriately assessing, working with, and treating criminally and mentally disturbed patients can encourage us to place such individuals in jail. But this only complicates matters and makes life easier on the mental health professionals and those in other helping professions. It is sort of like a “way-out” for us.

    It’s so complicated and this is why we cannot find a better solution.

    I agree with Lynn, we should have a separate facility for men and women, children and adolescents, younger and the elderly. It might also be useful to have separate facilities for separate problems such as a unit for depression, for suicidal patients, or for patients with schizophrenia.

    With more widespread discussions like the discussion(s) we have had, we may be able to influence systemic changes. The great thing about our discussion(s) is that we are “bouncing ideas” and this is always good.

    Very best

  21. Sorry for the LONG posts, I can be wordy!

  22. TH writes, “Of course we do not want to jeopardize other’s well-being, but we don’t want to “throw” away those who are difficult to comprehend and treat.”

    But,that’s exactly what’s happening. People are willing to sacrifice the safety and well being of those who have truly done nothing wrong to try and help those who have. That’s not right. A person with major depression who has not committed a crime is not the same as a person with major depression who assualts people. We’re not equals. If a physician knowingly admits patients into an environment where the patients are at risk for assault, then they are accountable when it happens.

    I think they need to decide if psych hospitals are going to be jails or places of healing. As long as they are admitting people who are violent toward others, it will continue to be run like a jail and people like myself will pay the price for it and leave with more even more wounds. It’s not lack of insight that causes people to flee psych hospitals, it’s the way they’re run. I like the idea of separate wards for major depression, etc. Maybe if people who haven’t committed a crime are all in one ward, the staff would recognize that and treat them with the same respect as patients on non-psychiatric wards.

  23. This post hits oh so close to home as I am dealing with violence on the unit that is not going to be controlled with medications nor repeated quiet room/seculsion visits, yet with the one case that is overwhelming staff, I will note putting the patient in jail will do nothing of substance as well. But, the needs of the many outweigh the needs of the few. It is a shame that administration does not see that basic principle. Sometimes, I really think that there are people who work in health care cannot say “enough” or “that is all I can do”. These are not words of abandonment, they are boundaries.

    Show me a doctor who took an oath to treat every single person who walks into his door, and I will show you a fatal optimist!

  24. Dr. John: This man is also a Psych professor, according to his LinkedIn profile. I am aghast at the idea that he is teaching future generations of community mental health professionals to make so-called “trade-offs” like this.

  25. I have my own history of anxiety and depression that started as a child. I have been alcoholic since the age of 13. I sought out treatment for the depression at the age of 21 ,never seeing the alcohol connection. I had been taking a very active self help approach to my problems and 20 plus years later I am working in the field. Still working on my own recovery and I have worked in the hospital in question , having said that here are my thoughts about mental health care. None of the problems will be effectively or permanently resolved until the attitudes of society are changed and we get to the root of the problems earlier before we need to consider prisons or hospitalization.
    We as a people minimize our own behaviors that contribute to emotional , spiritual , and mental unwellness. We have created a rude loud and sinical society that feels the successful have made it by their own efforts and if another is struggling or doesnt have the skills to be healthy or successful it is their own doing and we are not responsible for our fellow man. If each individual would take a minute to be truly grateful that their own shortcommings have not produced the sorrow and struggle others face and count their blessings 10 times for having DNA that wholly contributes to their being physically healthier and socially more accepted making life somewhat easier. I will never give up advocating for the need for better environments , I have learned it is really hard to be Ghandi in the ghetto. I have experienced really lousy attitudes by the staff at the hospital that I personally witnessed causing escalation in patients leading in one inidence a need for security to be called.
    That hospitals decore would make anyone feel miserable add a staff attitude that condones speaking to people anyway they see fit be it from burn out or the hostility that comes from judgement over how the patients got there somehow it is condoned. Correct use of tone , cadence and volume would go a long way to easing the tension that is leading to patients attacking one another .Perhaps being respectful in spite of a persons history would make where we put people a non issue, neive maybe but I strongly feel it is something that needs to be considered. The behavior of staff at a mental health facility is no less important to patient recovery than medicines administered by medical professionals at a medical facility. We would never sit back and say nothing if burned out medical staff administered the wrong medications why do we make excuses for the conditions that exsist in mental health facilities. Is it because “those people ” needed to make better decisions for themselves and why should we pay for people who we are not responsible for? I think our county executive Scott Walker is responsible for conditions as budget cuts get him elected and his constituancy surely wants to pay as few taxes as possible ,of course . I would ask anyone considering electing him for Governor to think about the consiquences of electing him .

  26. Again, I think as long as they’re mixing in people who have committed a crime(s) with those who haven’t attitudes will not change. I was reading about places like Wellspring and Meadow Haven where they treat people who have been involved in cults, experienced abuse by authority figures like therapists and clergy, etc. If what I read about those two places is what actually happens in practice, then i think they’re much closer to the type of environment needed for those suffering from depression and who have a history of abuse. It doesn’t make sense what psych hospitals are doing. The psych hospital, from what I experienced, was completely opposite of the type of environment a person with depression needs. No sunlight, greasy/unhealthy foods, threats by staff, seeing patients taken down & chemically restrained, being treated like children, knowing that my voice didn’t matter even though I signed in “voluntarily,” the place smelled like urine, knowing I was in with people who had committed crimes, watching a nurse rip a phone out of a patient’s hands, reinforcing helplessness, no exercise, etc, etc. I needed to be in a place where I was respected, where I was treated like an adult, and where I knew my voice mattered. I needed to be impowered not beaten down. It’s sad that so many people who are depressed go into these places only to leave with more wounds. If only I had ended up in a place like Wellspring or Meadow Haven, I think it would have made a world of difference in my recovery.



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