A Question of Assault

By Barbara Barnes posted 12-09-2009 12:06 AM


As a practicing psych nurse on a busy acute care county unit, I have seen and experienced my share of violence.


I am disappointed that patients who assault are rarely charged and I have been told by law enforcement that nurses shouldn't bother to press charges since the DA will drop it and label them mentally ill and not competent.


I am writing a letter to my local DA to ask for support to change the perceptions of the mentally ill and the practice of treating patients exactly the same. I try to define the spectrum of disease from mild depression to personality disorders, patients with co-morbidity of substance abuse and psychotic, delusional and disorganized ill patients.

I highlight the literature on predictors of violence and that the most violent patients are usually patients with personality disorders and substance abuse.   


Research by Rice (2002); Haim (2002); Junginger (1998); Sacks (2009); and Svindseth (2008) has shown that patients with schizophrenia and psychotic symptomatology to be less violent. Individuals at high risk of violence towards staff are more likely to be substance abusers, have personality disorders and are angry because of a perceived lack of respect or a denial of service; e.g. asked to pull up their pants or has to wait to use a phone.  Many of these patients have narcissist, antisocial or entitled traits.  

These patients have no remorse and I have had these patients brag they could get away with killing a staff person.  A mood disorder should not be a get out of jail free card.


I would like to have legislation that mandates felony charges with health care staff assault.


What are other states doing about staff violence? I would love to hear about the consequences of staff violence in any acute care setting. 


I am working on a literature search for predictors of risk for violence. Has anyone done work on this topic? I would love to read your research.




11-06-2015 01:31 AM

In Michigan, they are charged with assault and go to court every time in the prison system. They just get more time. My prison has more psych patients than the average prison, and just had 50 more transferred in yesterday. It is about equal to working in the psych hospitals I've been to with the psych pt load. Except in psych there is no punishment for acting out and I agree most that act out are antisocial, narcissistic, borderline, and substance abusers. They act out for not getting something that they wanted or having to wait. I have been attacked so many times in psych even with an attempted strangling. Not one prisoner has acted out to that extreme due to threat of punishment. These patients do not need hospitalization, they need out patient therapy groups well at least the personality disorders. Need to screen admissions better.

09-14-2015 10:00 PM

In NC, starting Dec. 1, 2015 there's a new law making it a felony to assault any hospital worker. That's great and I'd like to see it carried over to include outpatient mental health centers and FQHCs. Plenty of assaults occur there, so why is it limited to hospitals. I believe it was brought forward by the NCNA but not sure if I'm remembering that correctly. It's going to get worse before it gets better, if that. Don't mean to be doom and gloom; it's reality.

03-31-2014 11:07 AM

I have done a lot of research on this topic as I work in on a forensic female admission unit in a state psychiatric facility. Aggression and the effects of aggression are an increasingly dangerous problem for staff with the decreased use of seclusion and restraint combined with an increase in general society violence. I am currently studying the effects of continued exposure to violence on psychiatric nurses and would be happy to share more research once it is completed. I am currently surveying nurses to determine their experiences with violence. http://community.apna.org/communities/alldiscussions/viewthread/?GroupId=7&MessageKey=6ac3de34-b5fb-4e28-a5d4-616a7117ff0b

01-29-2014 10:03 AM

In New York there is a law that if you assault a nurse it is considered a felony. However, that assault has to show severe injury for the person to get charged the felony (severe bruising, broken bones, concussion, lacerations, etc.) Our police officers also discourage us from pressing charges stating it will go "no where" since they have a "mental health diagnosis". However, most of the patients assaulting us are borderline personality disorder and substance abuse patients (patient's who know what they are doing). We also have the Justice Center Law now in New York, so if any patient feels they are talked to in a demeaning or bad way or restrained too rough, etc they can report us to New York State Justice Center and an investigation of that nurse pursues, that nurse can be suspended and lose her license with two complaints. Therefore the nurses are now not wanting to do any type of hands on with any patients and we getting away from restraining anybody. It is rough. There are patients out there that are abusing the system and reporting nurses just because they don't like the way they are "talking" to them even though the patients are verbally abusing the staff all day long and getting away with it. It's so frustrating. I don't know who to go to regarding this Justice Center. I like the idea of the Justice Center protecting our mentally challenged population which is what it was designed for but unfortunately our mental health patients fall under the umbrella of this law too. There was a patient on our unit that called the Justice Center several times a day every single day he was on our unit complaining about everything under the sun and made comments like "I'm going to shut this place down". He wasn't psychotic, he has a personality disorder!

10-20-2013 07:39 PM

It is amazing to me that the people who are caring for the mentally ill are being assaulted. There is no legislation to protect ??? Most employers do not support the employee when it comes to workers comp. Will you address the issue of employers standing behind their employee once injured??

09-12-2013 08:22 AM

We just started a new screening protocol on admission and after 24 hours of being hospitalized to increase our awareness to the potential dangers of patients. Our assault rates are intolerable and at no point should any person assume the risk of violence without being able to demand consequences. I always encourage my staff to press charges in hopes that on the other end, courts will find a way to make sure that patients maintain treatment/sobriety/therapy or be incarcerated for their actions if they don't comply.

05-04-2013 01:05 PM

I worked in both inpatient and juvenile detention some time ago. I do remember a time when we did tell patients that if they did violence on the unit, they could be charged. At the time, it was true.At that time, we also acknowledged that staff who are threatened or injured need to process this, not just suck it up as part of the job. I really do think that it served as a model of wellness for our patients. Working with juveniles, it was important for them to understand the systems: mental health and legal. I don't think that I met a young person who did not appreciate the education. Felony laws changed in PA while I worked in detention so that juveniles could be treated as adults for more crimes. Our center did extensive education about the law changes and the imlplications. It is not about threatening patients, but helping them to make better choices. Isn't that part of health education?

03-25-2012 08:34 PM

Hi, Barbara...
I agree with your point. My unit has at least 2-3 violent or potentially violent patients each week. Our staff has been hurt in many ways physically over the past year, with no recourse. They are told by our security to not bother pressing charges because the patient will get out of it because they are in a psych unit and must not know what they are doing. EVen worse than that is that we are a federal facility (VA), so any veteran at a civilian facility is transferred to use, regardless of the safety concern. We have had patients forced on us who have committed murder, animal and child abuse, domestic violence, violence towards hospital staff, etc. because they are veterans when they could just as easily been sent to the state psych hospital 4 miles away. I also agree with your findings on who is more dangerous. Our patients with true psychotic or mood disorders are the safer ones on the unit. the patients with addictions, axis ii, "thugs" are the ones we can't t urn our backs on. I know for a fact that real criminals feign mental illness to get admitted to our unit to avoid jail or worse. They put up a very convincing screen and can languish comfortably on the unit stirring up the milieu and at times intimidating or harming other patients as well as staff. BEing a VA patient also should not be a "get out of jail free" card. I am a veteran, and yet, even I am against the opinion that these patients are excused due to their thought processes. I have not looked at the literature yet on what you are exploring; however, I will do some looking myself and share with you.

11-29-2010 09:29 PM

A get out jail card for an inpatient psychiatric patient should not be diagnosis driven. Assault is assault. Isn't American due process part of our heritage. Inclusion of patients rights' ought to include their rights as citizens in our great country. Assault charges should be adjudicated the other matters are taken up in the US - by due process. To say that someone with a personality disorder is more likely to be assaultive should be tried by the merits of the indivudal case AND the evidence that we have to support claims of greater (or lesser) violence. To ask patients to consider this as part of "patient's rights" would be empowering. Anything less would be to exclude them from due process. I am sorry if you were ever hurt in an assult. I have been injured - more frequently when I was a psychiatric aide (in training to be a nurse) years ago. I was told (at one State facility) that is was not the "policy" of the facility to "allow" staff to bring forth charges.
Edmund Bouley, RN, PMHCNS

12-26-2009 07:16 PM

The situation is much the same here in Michigan. What message are we sending to our patients when we don't hold them responsible for their behavior? There are patients who should not be held accountable legally due to the acuity of their mental illness, but my experience with assaultive behavior is that most often the patient / assailant was well aware of what they were doing. We do try to hold patients financially accountable if they are intentionally destructive of property on the unit. Again, it's not so much about collecting the money but more about teaching them that they are responsible for their behavior and its conseqences.
I was recently involved in enacting a duty to warn, notifiying police and specific individuals (including a judge) about very specific and detailed threats that a patient made. The prosecutor's office did not proceed with any legal charges since the threats "were made in a mental institution."

12-15-2009 12:00 PM

I agree I did press charges on a woman who kicked me in the stomach ans knew what she was doing. This was her first time charged after numerous very dangerous incidents. I was contacted by the prosecutor's office and the woman who intervenes tried to talk me out of pressing charges, eventually I agreed to the patient to have pre-trial intervention. My ultimate purpose in charging her was to have her overseen for some sort of treatment and medication compliance she has put many other people in danger, even minors, Our security guards are starting to press charges against dangerous patients (usually substance abuse) I feel hospital administration just does not realize the extent of these incidents since ED (I work in Crisis in an ED) staff in general seem to feel this abuse comes with the job and it is usually not reported. As far as pressing charges we do all the legwork, court , paperwork on our own time so it is not done enough. I was out for 5 weeks for minor surgery (not work related). After returning after weeks away an abusive patient (who exposed himself and urinated in the hall in front of staff and other patients) came in I felt like a bettered woman and am seriously considering leaving this position. Thanks for the venue to vent these frustrations, I look forward to others doing the same.

12-14-2009 11:35 AM

Thank you for doing this valuable work. Alice Atwood, RN