Handling Violence in Mental Illness Treatment Facilities

On a normal day, I could have walked away.

Very few of my neighbors in this mental illness treatment facility are violent. That said, one of my neighbors, who has a history of aggression, recently started cussing me out with a mix of b-words and f-bombs, then challenged me to a fistfight. I took off my glasses and said I was fine with that as long as she threw the first punch. She told me ""#$%!, you throw the first punch, I ain't crazy!" and a social worker came and broke it up.

I went to my apartment and immediately had an asthma attack (Physical Disorders with Panic-Like Symptoms). I also punched a wall, bruising three knuckles. Not my finest moment, and not normal for me. But afterwards, I thought about what should happen when violence in mental illness treatment facilities becomes a problem.

Zero-Tolerance for Violence in Mental Illness Treatment Won't Work

If the facility had a zero-tolerance policy, we both would have been kicked out. But would that be the best way to handle it?

Under normal circumstances, I am a devout pacifist. I usually can walk away even with a tirade of profanity being thrown at me. But, in the past week, I've watched a two-year-old niece undergo surgery and buried a childhood friend; stressors that could make anyone short-tempered. Should extenuating circumstances be considered if there is an incident of violence?

In addition, I have no history of violence. The other person, however, does. Should a person with no history of violence be treated the same way as a person with a lengthy history of violence?

That's not to say there weren't consequences. I was hospitalized for three days as a direct result of The Incident. I get the feeling that there will be further consequences. That said, the aggressor and I shouldn't get the same punishment. And in an ideal world, we wouldn't.

What If Violence Is Out-of-Hand in a Mental Illness Treatment Facility?

When I was on the borderline unit at Larue Carter, a state hospital in Indianapolis, we had a patient who was violent. At first her aggression was limited to staff. Then, one day, it was unleashed on a patient and yes, it was me.

She cussed me out because I asked to use the phone. Staff separated us, got me calmed down, and I went out to use the phone. Suddenly, she yelled a few insults, put her face mere inches from my face, and growled "Move." I refused, and she shoved me.

Did I mention this patient weighed 500 pounds? Laws of physics were not on my side that day. According to witnesses, I flew back a good four feet, landed, bounced, and landed on my head. Staff took me to the emergency room with a concussion, and suddenly every patient on the unit started standing up to the bully. Staff also began documenting every incident of violence she was involved in. They'd neglected to file paperwork earlier. When she tried to break a staff member's hand less than 24 hours after sending me airborne, she was kicked out of the program.

Violence in Mental Illness Treatment Facilities Should be Punished Case-by-Case

There has to be a line. Everyone involved needs to know what that line is. And when that line is crossed, there need to be consequences. While mental illness should be factored in when deciding how to handle a violent incident, it should not be an excuse. When violence accompanies mental illness, we need to ask:

1) "Were there extenuating circumstances?",

2) "Has this happened before?", and

3) "What consequences can there be to ensure this doesn't happen again?"

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