Introduction to the debate on
Protection of Hospitalized Mental Patients
Against Sexual Assault and Abuse
Mordechai Halperin, M.D.
The Shereshewsky Committee
Following recurrent publications of complaints concerning abuse of hospitalized mental patients, an investigation committee was set up under the direction of former Supreme Court Judge, Dr. Benzion Shereshewsky, to investigate and submit proposals for improving the situation. The committee, appointed by the Minister of Health (Mr. Ehud Olmert) and his deputy (Mr. Eliezer Mizrachi), consisted of senior experts in the relevant fields.
The committee concluded that there are, in fact, incidents in which hospitalized mental patients had been victims of sexual assault and abuse. These include cases in which women gave birth or had abortions, as well as cases in which families broke up as a result of the offenses. The report concluded that since the psychiatric wards presently accommodate members of both sexes together, it is very difficult to protect the patients sufficiently as the law requires. In the light of this situation, legal suits are liable to be filed against the directors of hospitals and psychiatric wards where the offenses occurred.
Separation and Mixing of Sexes in Psychiatric Wards
Until the 1960’s there was total separation of the sexes in psychiatric wards – i.e., separate wards for men and for women. Later this policy tended to change to accommodate men and women in the same ward, but in separate rooms. The main argument in favour of this change was the assumption that male and female patients would neglect themselves less in a mixed ward, due to the presence of members of the opposite sex, and that the presence of women in the ward might curb violent behavior among males.
However, the committee noted that professionals in the field had differing opinions on this issue. Some claimed that the improved behaviour noted among patients was due to the change to mixed wards, while others claimed that the improvement was mainly due to the introduction of advanced therapeutic methods and new medicines. The committee also heard reports of separate sex wards which functioned satisfactorily. In view of this professional disagreement, the committee also investigated the issue on the assumption that some patients might indeed benefit from mixed wards.
However, since sexual abuse of a hospitalized mental patient may cause serious damage, not only by destroying the family unit, but also by creating additional problems, the committee concluded that there is no justification for introducing measures which might harm one patient even if others were thereby to benefit.
The operative conclusions of the Shereshewsky committee were carefully drafted in order to provide a balanced presentation and to preserve individual rights.
The conclusions call for the establishment of separate sex wards, alongside with mixed wards, in order to protect patients who are unable to restrain their sexual behavior and for patients who demand full protection for themselves, or whose families demand that they have full protection.
The members of the committee, who signed the report unanimously, sought to make it clear to the directors of hospitals and psychiatric wards that they are subject by law to penal and civil charges should any patient hospitalized in a mixed ward be sexually molested.
The Minister of Health notified the members of the committee that he intended to implement their recommendations and that in accordance with the resolution adopted by the Ministry the Division of Mental Health Services was instructed to implement the Shereshewsky Report.
The Deputy Minister of Health in charge of psychiatric services provided by the Ministry considered implementation of the Shereshewsky Report to be an important step towards preservation of individual rights, particularly of mentally ill individuals and hospitalized mental patients. The Deputy Minister considered care of the individual and preservation of individual rights to be an extremely important challenge that faces modern health care systems, as well as an essential element of democratic society. In modern health care systems, the rights of the individual patient are often eroded, and it is the obligation of society to render full protection.
The session dealing with the Shereshewsky report at the 3rd International Congress on Psychiatry, Law and Ethics (Jerusalem, November, 1991) was one of the most exciting sessions of that Congress.
For the benefit of the readers of JME, the full text of the Shereshewsky report is reprinted here. Following the text of the report are three lectures which were presented at the International Congress by senior members of the Shereshewsky Committee.
We hope that the ensuing discussions will contribute to the important issue of the civil rights of the individual.
Source: ASSIA – Jewish Medical Ethics,
Vol. II, No. 2, May 1995, pp. 30-31