Situations like this bring up the tough question of bringing in the police if an antisocial person breaks the law on an inpatient unit.
In cases like the above, sometimes the police don't want to respond. The police, wanting to avoid paperwork, and thinking the person is in a safe environment, want to avoid these things.
But in cases like this, antisocial people need to be held accountable for their actions. What do you do then if the police refuse to show up? I've seen that happen. Are you violating privacy? That's not been definitely answered. I've even seen a forensic psychiatrist (that's a PD and that I have little respect for) argue in court (after he was well paid) that since the alleged crime occurred "in house" it really should be handled by a hospital.....and the law shouldn't have any involvement. In that case, the attacker fit the above description, an ASPD patient who truly had no severe mental illness, and whose only real Axis I dx was substance abuse. In his case, he brutally attacked a psychiatrist who suffered permanent neurological damage.
A committee at AAPL including a former AAPL president did mention in a conference that it was their opinion that patients that commit crimes on an inpatient unit need to have the law involved. If the person's mental illness (I'm talking about a "real" one, not ASPD) did contribute to the crime, it shouldn't be medical staff determining if the person should face punishment, but the judicial system.
This phenomenon is not something you're going to see in all scenarios. You are more likely to see it in an urban setting that services poor and high crime areas.
Another similar phenomenon is what do you do if you're working on a forensic unit (like I am) and you got someone found not guilty by reason of insanity for a serious crime, and the person is not truly mentally ill? I've had that happen twice. In these cases, I took the person off of medications, and after several months of observation, and the person still did not show any symptoms, you're supposed to tell the Court. I wrote in my opinion the person was not mentally ill. The Court will likely ask for a second opinion, but then after that, if the second opinion agrees, the Court (now looking stupid because it's likely the same judge who found them not guilty by reason of insanity) will have to let them go.
(Yes, I did thoroughly review the cases including very lazily done reports saying the person at the time of the crime was mentally ill to the degree where they could not tell the difference between right and wrong, and in each case no one did a urine drug screen, the person had a long history of drug abuse, and had a trail of several idiot doctors saying the person was mentally ill).
It's already been established in Foucha v. Louisiana that if someone was found not guilty by reason of insanity but they are not truly mentally ill, then they are supposed to be released, even if you think the person is still dangerous. It is my opinion that if someone malingered to be found mentally ill and successfully used a not guilty by reason of insanity defense, then the Court yes must let them go for their crime, but should then charge the person with perjury. I, however, have yet never seen this happen, and it's considered inappropriate for me to call up the Judge and say "Your Honor, since you can't nail this guy via method 1, use method 2, perjury!"
In the cases I've had so far, the first guy was still held because he is in the hospital for multiple crimes. I only got him off the hook for one (and trust me, my goal was not to get him out, it was to pursue the truth...the truth that the guy is not mentally ill, shouldn't have been hospitalized in the first place, and I will not medicate someone because 10 previous doctors were wrong).
In the other case, the guy is still in the hospital but will likely be released because the other doctor who reviewed the case agreed with me. The person in that case has been off of meds for several months and the only problematic behavior we see is all due to ASPD. I even wrote in my report that the guy will likely commit a crime again, even possibly harm someone, but I will not say a person is mentally ill if I don't believe they are.
And since I'm all ticked off at the moment, I'll just OT add that I had a suicidal patient in my outpatient office a few days ago who had panic disorder and depression, I had her hospitalized, and the inpatient doctor took her off of all her meds, (she said they worked, she told me she was suicidal because of an severe incident at work) put her on lithium, diagnosed her with bipolar disorder even though she had no complaints that fit a DSM dx of the disorder, and discharged her. His report mentions no DSM criteria for bipolar disorder.
And unfortunately I see a lot of doctors practice the way the above doctor does.
