When should inpatients who exhibit violent behaviors be prosecuted?

Acts of physical violence perpetrated by inpatients on hospital staff are pervasive, erode staff morale, and consequently lead to burnout; these acts of physical violence are all too often ignored or minimized. The human costs of such violence are slowly being recognized, but systemic response lags. In this article, it is argued that under some circumstances criminal prosecution of patients who have exhibited assaultive behavior is an ethically and clinically appropriate response. Prosecution should be an option particularly when assaultive behavior on the part of the patient is clearly instrumental, planned, and believed to stem from antisocial attitudes rather than severe mental illness. Experience has shown that for this intervention to be effective, “stakeholders,” including local police, prosecutors, and hospital administration, must collaborate and agree upon a process whereby specific acts of violence can be addressed by the criminal justice system.