Factors affecting the decision to prosecute mental patients for criminal behavior

Several authors have argued that under certain circumstances it is both necessary and therapeutic to bring criminal charges against psychiatric patients who have committed assaults or manifested other criminal behavior. Others have argued that prosecution may impair therapeutic alliances and may lead to increased litigation by patients. In this paper the authors present four cases in which patients in the public mental health system were prosecuted, and they discuss factors that affect the decision to pursue prosecution. They argue that both clinicians and legal professionals need specific training to help them recognize the differences between behavior that a patient's illness prevents him from controlling and impulsive behavior, stemming from character pathology, that can appropriately be addressed by criminal sanctions.