Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP)

Sources of Social Support After Patient Assault as Related to Staff Well-Being

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

Effects of a peer support programme for youth social services employees experiencing potentially traumatic events: a protocol for a prospective cohort study

INTRODUCTION

The use of peer support programmes to help workers experiencing potentially traumatic events (PTE) has increased in high-risk organisations in the last decades. However, the scientific evidence of its effectiveness is still very limited. This paper aims to describe the protocol of a prospective cohort study that assesses the efficacy of a peer support programme among youth social services employees exposed to a PTE at work on psychological well-being, work functioning and needs of support.

METHODS AND ANALYSIS

This is a mixed-methods prospective study that will examine workers' evolution four times over a 12-month period in Canada. This study involves: (1) quantitative data obtained through self-administrated questionnaires among 222 workers, and (2) qualitative in-depth interviews with a subsample of 45 workers. This study will compare findings from a cohort who received the support of a peer following a PTE (peer support-experimental protocol) as part of the experimental protocol of the Montreal Youth Social Services-University Institute (MYSS-UI), the second group of workers did not ask for the peer support (no peer support-experimental protocol) but was part of MYSS-UI, and the third group received standard organisational support from the Monteregie Youth Social Services (MYSS) (standard organisational protocol).

ETHICS AND DISSEMINATION

The protocol and informed consent form complied with the ethics guidelines of the MYSS-UI. The Research Ethics Board of MYSS-UI and MYSS reviewed and accepted the protocol as required. The results of the study will be published in peer-reviewed journals, presented at research and general public conferences, disseminated via a public report for the institute that funded the project and for all workers. Results of this study will influence decision making regarding intervention policies following PTE and peer support interventions may be expanded throughout the youth social services in Canada and worldwide.

Women in acute psychiatric units, their characteristics and needs: a review

Aims and method Recent policy guidelines published by the Department of Health highlight the need to develop gender-sensitive psychiatric services. However, very little is currently known about the specific characteristics and needs of female patients entering acute psychiatric wards, particularly psychiatric intensive care units. This article aims to review the current literature on what is known about this group of patients. PubMed, Embase and PsycINFO were systematically searched using a number of key terms. Results A total of 27 articles were obtained. The findings were divided into four categories: admission characteristics, treatment needs, risk management and outcomes after discharge. Gender differences were found in diagnosis and presentation. Clinical implications The differences observed in the reviewed studies suggest that women may have different assessment and treatment needs, and ultimately, different philosophies of care. A dearth of studies in this area indicates that if services are to develop in line with government policies, more research is needed.

Meeting the needs of women in secure mental health: a conceptual framework for nurses

Within the wards of Britain’s high and medium secure mental health services, the needs of the female population differ significantly from those of their male counterparts. Although much smaller in number, the vast majority of female patients formally detained in secure services are young, Caucasian women, who are less likely to be prone to criminality and have a propensity to suffer from psychological distress. Many have experienced extensive trauma and exhibit both internally and externally driven violence. Drawn from the women’s own narratives and analysed using a descriptive phenomenological approach, the findings provide the basic structure for a new ‘humanistic conceptual framework for care’ which could be used by mental health practitioners to both inform and structure the daily provision of care and to better understand the physical and mental health needs of this unique patient group within secure mental health services.

Characteristics of American assaultive psychiatric patients: review of published findings, 2000-2012

Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.

The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program

Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.

Women in medium secure care: tracking treatment progress for changes in risk profiles and treatment engagement

The treatment and risk management programmes in a women's medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research.

Aggressive behaviors in the psychiatric emergency service

Introduction:

Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and, on event prediction, using behavior-based clinical rating scales. Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification.

Methods:

We used a prospectively acquired database of over 20,900 visits to four services in the province of Quebec, Canada, over a two-year period from September 2002 onwards. A maximum of 72 variables could be acquired per visit. Visits with aggression (any verbally or physically intimidating behavior), both present and past, were tagged. Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression.

Results:

About 7% of visits were marked by current aggression (verbal 49%, physical 12%, verbal and physical 39%). Including visits with a “past only” history of aggression increased this number to 20%. Variables associated with aggression were gender (male), marital status (single/separated), education (high school or less), employment (none), judicial history (any type), substance abuse (prior or active), medication compliance (poor), type of arrival to psychiatric emergency services (involuntary, police, judiciary, landlord), reason for referral (behavioral dyscontrol), diagnosis (less frequent in anxiety disorders), and outcome (more frequently placed under observation or admitted).

Conclusion:

Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service. Although their sum may not add up to a specific patient profile, they can nevertheless be useful in service planning, being easily integrated alongside state-dependent rating scales in a triage and/or observation instrument for daily use in the psychiatric emergency service.

Characteristics of assaultive psychiatric patients: 20-year analysis of the Assaultive Staff Action Program (ASAP)

Empirical research demonstrates that patient assaults on staff are a worldwide occupational hazard. This study examined patient assailant characteristics in a 20-year longitudinal, retrospective study in one public health care system. Older male patients with schizophrenic illness and histories of violence toward others and substance use disorder and younger male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use disorder were the more frequent assailants. This was true at 10-, 15-, and 20-year periods. Specific clinical findings with regard to forensic patients, the violence triad, and victimization of women as well as methodological issues were discussed and the implications noted.

A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements

This review examines the research on ecologic factors that may contribute to or lessen the likelihood of inpatient unit violence. Understanding these factors can provide psychiatric inpatient unit staff with valuable therapeutic relational and cultural strategies to decrease violence. International and US studies from OVID Medline, CINAHL, and PsycInfo that evaluated aggression and violence on psychiatric inpatient units between 1983 and 2008 were included in this review. The review revealed that violence results from the complex interactions among the patient, staff, and culture of the specific unit. Inpatient psychiatric staff can decrease the potential for violence by using therapeutic relationship strategies such as using good communication skills, advocating for clients, being available, having strong clinical assessment skills, providing patient education, and collaborating with patients in treatment planning. Cultural improvements include providing meaningful patient activities and appropriate levels of stimulation and unit staffing.

Severe mental illness and criminal victimization: a systematic review

OBJECTIVE

To estimate the prevalence of criminal victimization among people with severe mental illness and to explore risk factors.

METHOD

Four databases (MEDLINE, ScienceDirect, ERIC, and AMED) were searched for articles published between January 1966 and August 2007, supplemented with hand-search of reference lists from retrieved papers. The author and a Medical Doctor independently abstracted data and assessed study quality. Disagreements were resolved by consensus after review of the article and the review protocol.

RESULTS

Nine studies, including 5195 patients, were identified. Prevalence estimates of criminal victimization ranged from 4.3% to 35.04%. Rates of victimization among severely mentally ill persons were 2.3-140.4 times higher than those in the general population. Criminal victimization was most frequently associated with alcohol and/or illicit drug use/abuse, homelessness, more severe symptomatology, and engagement in criminal activity.

CONCLUSION

Prevention and intervention programs should target high-risk groups and improve patients' mental health and quality of life.

A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint

BACKGROUND

Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures.

METHOD

The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register.

RESULTS

The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures.

CONCLUSION

Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.