Where I live in Canada, the medical system is authoritarian. Doctors are almost never sued successfully for malpractice. This creates a realm of unaccountability.

I also think that antisocial people like psychopaths are attracted to fields of work where they can act with impunity so the psych wards will have more than their fair share of these people and they are also more likely to rise to the top and run things.

One patient who was locked into the secure ward inside the psych ward with me had a kind of dementia and he had not been outside to get fresh air or even allowed to walk on the main ward for over 6 months. He just walked in circles around inside the locked ward.