Obstacles to reducing patient abuse in public institutions.

Although the abuse of patients in state mental health facilities compromises the patients' therapeutic environment and strongly affects public conceptions of such facilities, there is a lack of reliable research and data on patient abuse. Drawing on his five-year experience as chair of the New York State Commission on Quality of Care for the Mentally Disabled, the author discusses the problems that binder the reporting, investigation, and prevention of patient abuse in public facilities. He believes that the reporting of minor abusive conduct is precluded by the very working conditions that contribute to its occurrence, but that the reporting of major abusive conduct is precluded by powerful factors in the administrative and disciplinary structures of state institutions. After discussing the problems behind the reporting of patient abuse, the author suggests some preventive measures to decrease the incidence of abuse and to ensure its reporting when it occurs.