Discharging the violent psychiatric inpatient

Since psychiatrists may be held legally accountable for their patients' violent acts against others, psychiatrists on inpatient wards are faced with the dilemma of deciding whether or not, and when, to discharge improved but still possibly dangerous patients. This paper presents a survey of an inner-city hospital's experience with violent patients admitted over a seven-month period and describes an interdisciplinary disposition committee, composed of a senior consulting psychiatrist and other mental health professionals, established by this hospital to help make these difficult decisions. The committee carefully evaluates all identified high-risk patients according to specific criteria before such patients are discharged. Two case studies illustrate this process of evaluation.