Releasing dangerous patients




Today the Guardian Newspaper published a report pleading for sympathy for psychiatrists who release mentally ill people who threaten to kill.

What’s shocking to me, apart from the relentless self-pity, is that the psychiatrist author shows no concern whatsoever for the well-being and safety of his patient, their family, or of the wider public.

It’s no wonder so many preventable tragedies continue to occur.

It’s no wonder the number of homicides by people with mental illness is increasing.

The author remains anonymous and unaccountable – (as so many of their profession) – and despite the plea that the sword of Damocles is hanging over his head should his patient cause harm, the reality is that in very many cases, psychiatrists are very rarely named or held to account when their patients kill themselves, their families or members of the public.

He says that ‘medication has made the psychotic symptoms disappear’ – but fails to consider what will happen, if, as so often happens, the patient fails to take his medication, or goes on a drugs binge that negates its therapeutic effects?

Our experience is that many homicides and suicides have their origins when seriously un-well people are unable or unwilling to get the treatment they need.

And despite what they say, there is something this psychiatrist can do.

They can give their patients effective care and treatment, they can stop treating just the symptoms, and, perhaps just for once, they can take responsibility for treating the whole person.


My patient told me he is going to stab someone. There’s nothing I can do


Thursday 13 October 2016

“I’m going to go home and I’m going to stab someone.”

Alan is in the weekly ward review meeting with a group of doctors, nurses, and students. We’ve told him we think he is well enough to leave the ward; he disagrees.

I am a consultant psychiatrist with a team working in a secure psychiatric inpatient unit, where he has been treated. He is unusual in that he has had his first psychotic episode later in life. The rest of his story is more depressingly typical; a chaotic childhood, expelled from school, periods in care and prison. He received no professional help and was left to drift between prison, homelessness, alcoholism, using drugs and managing only tenuous, readily broken relationships. Alcohol in very large quantities has, arguably, been what has kept him going, cutting him off from his unfortunate reality.

Possibly because of the alcohol, he began to hear voices and has had a spell in hospital where he was violent towards the staff. Medication has made the psychotic symptoms disappear.

But he doesn’t want to go home. He’s no longer psychotic, but his habit of violence hasn’t disappeared with the voices. If he stabs someone and ends up back in prison he doesn’t care.

So what to do about Alan?

He now has the capacity to make decisions about his actions. He understands, on one level, that being violent towards people is not the best thing to do. He doesn’t care though. Alan is the product of an unfortunate combination of nature and nurture that has left him with an inability to manage even the most minor frustration. If I had been seriously hurt by his actions the police would, probably, have agreed to arrest him. I find myself wondering aloud if that might have been easier for us all.

But the CPS would almost definitely have refused to follow through because Alan has been sectioned in the past and has mental health problems. Mere threats to kill if discharged from hospital will attract little interest from the criminal justice system, although we will go through the motions of talking to the police. Alan is in the mental health system now. The reality is that anything Alan does in the future can come back to bite any mental health professional who has had anything to do with him.

His case joins the many others creating the great sword of Damocles hanging my head and that of most psychiatrists. He can’t stay in hospital for ever. He attacked people before he became psychotic, usually when drunk; he is likely to again as he doesn’t even pretend to want to give up alcohol.

I will try not to worry about Alan stabbing someone. I hope he is bluffing. We will contact the police and will document in detail our view that he is now responsible for his behaviour – and we will discharge him.

Alan is not his real name and some details have been changed


One Reply to “Releasing dangerous patients”

  1. “Alan” sounds like somebody I know???? strange!! He told his psychiatrist he was having visions of knives and sharp objects and was being “told” to hurt somebody. His psychiatrist let him walk out of his office that day…………He stabbed somebody 5 times a few days later.

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