A violent psychiatric patient who threatened to chop the heads off police during a psychotic episode last week is missing.

Police have issued a public safety alert for 37-year-old Ashley Patrick Koftinoff, who failed to return to the Hillside Psychiatric Centre next to Royal Inland Hospital after he was issued a one-hour pass to leave on Monday night.

Koftinoff is described as six feet tall and 208 pounds and was last seen wearing black jeans, a blue shirt and a camouflage tuque.

On Friday, Koftinoff sent Hillside staff scrambling behind a security barricade and had to be Tasered and restrained by several police officers when he went on a violent tirade in the psychiatric facility, pulling a pipe from the wall and swinging it threateningly.

Koftinoff has a history of legal trouble involving violence going back to 2004 when he was arrested in Castlegar for assault and uttering threats to cause death or bodily harm.

He spent five years out of the legal system, then in December 2011 he was arrested along with four others for cocaine trafficking.

Most recently, he didn't show up for a June 13 court date in Castlegar for inducing fear of injury or damage.

Personnel at the Nelson Crown office, which oversees Castlegar provincial court, said a warrant was issued and held pending Koftinoff's anticipated court appearance Wednesday.

If he doesn't show, the warrant will be sent to authorities.

Hillside physician Dr. Paul Dagg said he couldn't disclose the circumstances of Koftinoff's one-hour pass on Monday, but suggested staff had assessed the patient as stable after he was medicated.

"When violence or aggressive behaviour is a result of a psychotic illness, and we treat that psychotic illness with medications that are effective, it's not unusual for us to see substantial recovery within a few days," said Dagg.

Hillside uses a complex system for passes that spans a spectrum of freedoms from 15 minutes escorted inside the building to outside unescorted passes.

He said the decision to issue a pass is made on a day-by-day basis.

"It's part of helping people recover and get out of hospital — at some point we have to open the door," said Dagg. "So we do that based on an assessment in the moment by the nurse who's at the door at that moment. But also that day there's an assessment by the team as a whole before passes are increased."

He said assessments also take into consideration the patient's past behaviour and try to predict future behaviour. But there's always a risk.

"As soon as the locked door is open that person has the opportunity to AWOL," he said.

Last May, a 23-year-old patient with a history of violence grabbed a Hillside nurse by the throat and ripped away her security card to escape.

The man set off a hunt involving a police perimeter after elbowing an officer who had approached and escaping. He was later caught by police.

In May 2011, a Hillside patient on unescorted leave stole a parked and idling SUV from a West Victoria Street rental company, tried to drive it into a police car and bit an RCMP officer. She was subsequently sentenced to 14 months in jail.

Whenever episodes of this nature occur, said Dagg, facility staff takes it as a learning opportunity.

"In this particular instance (Koftinoff going AWOL), no staff were injured and my first quick review is that we work very well with the police… and it appears that there was really good teamwork and collaboration to minimize the risk to everybody involved," he said.

Staff will undertake a more extensive review of Koftinoff's psychotic episode last Friday, said Dagg.

"We have done this in the past and overall we have decreased the number of people who go AWOL from our facility on a year-by-year basis as a result of some of the changes we've made."

Hillside opened in February 2006 with 44 beds, 10 slated for geriatric patients, nine for adult general psychiatric patients and 25 for the province's neuropsychiatry program.

Since then, staff from similar facilities throughout Canada have visited to learn how Hillside treats its patients, said Dagg.

"(They) learn how we operate in order to look after clients who can be challenging in as safe a manner as possible and that's something that we take very seriously."