Homicide in a Psychiatric Institution

Abstract

A unique case of a homicide committed by a young male psychotic inpatient on a fellow-patient is reported and discussed with regard to the special victim-offender relationship, the relationship between suicide and homicide, the phenomenon of aggression and the question of the management of a highly suicidal psychotic patient, including the issue of continuous observation.

Suicide in secure psychiatric facilities

“…The clinical literature also contains descriptions of patients in psychiatric hospitals who have killed other patients, having suicidal ideation either before or after the homicide, or both (e.g. Modestin & Boker, 1985).…”

The In-Hospital Suicide: A Psychological Autopsy of a System Involving Borderline Dynamics

“…Arguments in favor o f and opposed to t his stra tegy exist. Some authors suggest that special precautions may b e so e xaggerated as to bring about an attempt through suggestion or that e xtre mely se vere restriction may lead to suicide because of increased di scomfort and/ or adoption ofa " su icid a l identity" (14). These authors claim some clinical evi dence for th e assumption that if psychiatric personnel do not treat a patient as a suic id e r isk, the probability will decrease.…”

“…This sh ould in clude th e use of a ntidep r essa nts and/or neuroleptics and co ns iderat io n of ECT. Modest in a nd Boker (1985) suggest that the most appropriate initial treatment for a hi gh ly suicidal patient with psychotic depressive symptomatology and a h igh le vel of tension would be immediate powerful sedation to the extent of inducing psych opharmacological sleep with sedative neuroleptics, with addition of ben zodiazepine, or barbiturates if necessary" (14). c) Changes in search procedures.…”

Homicide in Psychiatric Hospitals in Australia and New Zealand

“…tims were older and more chronically mentally ill (7,8). Another report described the violent homicide of a vulnerable patient by a severely ill fellow patient in an overcrowded chronic ward (9).…”

“…Other published case reports described the homicides of doctors, nurses, and other mental health professionals (10)(11)(12). A common theme in the published reports has been the devastating effect that homicides have on staff morale and other aspects of the mental health service (7,9,11,12).…”