Characteristics of assaultive psychiatric inpatients in an era of managed care

The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting

Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.

Forensic psychiatric inpatients and aggression: an exploration of incidence, prevalence, severity, and interventions by gender

BACKGROUND

Previous investigations suggest that women judged to be not criminally responsible on account of mental disorder (NCR-MD) differ markedly from their male counterparts in important ways, underscoring the necessity of subsequent study.

OBJECTIVE

The goal of the present study was to inform our understanding of the presenting profile of female forensic psychiatric patients and contrast their risk of inpatient aggression with their male counterparts.

METHOD

The population of patients assessed and/or treated at a secure Canadian forensic psychiatric hospital were available for study. In total, 527 patients had complete data and were part of intensive retrospective file reviews; inpatient aggression was evaluated using the Overt Aggression Scale.

RESULTS

Women were no less likely than men to have a violent index offence and to perpetrate inpatient aggression. Examining the range of aggressive behaviours and severity levels did little to increase the relevance of gender to inpatient risk.

DISCUSSION

Female forensic patients represent a highly selected subgroup of women with exceptional clinical and behavioural challenges and associated treatment needs.

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.

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

Nearly thirty years of published research has documented the continuing presence of patient assaults on staff. These studies have included the traditional male patient with a diagnosis of schizophrenia and histories of violence and substance use disorder and the newer female, personality-disordered individual. This study reports on a ten-year longitudinal analysis of assaultive patients in one public-sector mental healthcare system during a period which included the national shift toward managed care initiatives. Data were gathered in the context of the Assaulted Staff Action Program, a crisis intervention program for staff victims. Patient assailants in both inpatient and community settings included both the traditional and newer personality-disordered individuals. The majority of assailants were females. Managed care initiatives appeared to have had little impact on type of assailants. Implications for safety and treatment are discussed.

Characteristics of assaultive psychiatric inpatients: updated review of findings, 1995-2000

The present paper reviewed the studies of the characteristics of assaultive psychiatric inpatients from 1994 to the present. These studies partially confirmed earlier findings that assaultive patients are older persons with a diagnosis of active psychosis or other neurological abnormality and histories of violence toward others and substance-use disorder. However, the recent studies also document the profile of a second group of assaultive patients: younger females with personality disorders and histories of violence toward others, substance-use disorder, and personal victimization. Since there is a paucity of published empirical research on Alzheimer's and dementia patients for this topic, the implications from the present findings for long-term care and clinical intervention are examined.