So there's a difference between Shadybrook, Hellgate Prison, and HHN 2004's marketing/theme.
Psychoscarepy takes place inside Shadybrook Asylum, which wasn't featured in 2004. Hellgate was, obviously, the prison house featured that year.
BUT...
The marketing for 2004 used this guy for the "Breaking Point" angle, with other images featuring his face with cracks (aka "Breaking")
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It was less about a mental health patient, and as
@Wesker69 pointed out, more about what fear does to a person. He wasn't a villain, but a victim of all the horrors he experienced.
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Or Bloody Mary in 2008.