Assault behaviour in acute psychiatric wards and its relationship to violence in the community: a comparison of two health districts

The management of violence in general psychiatry

There is increasing concern about the level of violence within mental healthcare settings. In this article I review what is known on this subject, discuss the relationship between mental disorder and violence and summarise the different ways to prevent and manage violence. When planning strategies to prevent violence in such settings it is important to consider not only patient risk factors but also risk factors in the environment. Staff need to have all the possible techniques for managing violent behaviour available to them in order to weigh up the risks and benefits for any specific patient in any particular situation.

Violent behavior of patients living in psychiatric residential facilities: a comparison of male patients with different violence histories

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.

Prediction of inpatient violence

OBJECTIVE

An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given.

METHOD

To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence.

RESULTS

Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts.

CONCLUSION

The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.

Violence in the accident and emergency department – An international perspective

Violence and aggression experienced by emergency nurses has been the focus of international concern. This paper examines the phenomena of violence experienced by emergency department nursing staff from an international perspective by reviewing original, published research studies. Methodological inconsistencies and concerns, a lack of comprehensive studies and persistent under-reporting may mean that the reality of clinical practise has not being captured by researchers. The literature suggests that clients presenting with weapons in the emergency department may be characteristic of North American departments but is much less likely to occur in the United Kingdom were weapons use is much more likely to be opportunistic. Excessive verbal abuse is a global phenomenon and nursing staff and organisations may be significantly affected by workplace violence. However, violence against nursing staff remains poorly researched or understood.

Responding to inpatient violence at a psychiatric hospital of special security: a pilot project

Within secure psychiatric hospitals, staff have to manage many difficult and challenging situations. Crichton (1997) suggested that when staff perceive a greater degree of responsibility on patients for their actions there is a particularly morally censorious response. The aim of this pilot study was to discover if this association, discovered using a hypothetical scenario, was also present in how nursing staff respond to real violent patient behaviour. Over a five week period all episodes of inter-personal violence in a hospital with special security were identified and those involved interviewed. Thirty-one episodes of inter-personal violence were identified. A disproportionate number were caused by female patients and patients detained under civil sections of mental health legislation. A personality disorder diagnosis and the staff belief that mental disorder did not reduce the individual patient's blame for the incident were associated with the response of a restrictive sanction (both cases p < 0.01).

Psychiatric in-patient violence: issues of English law and discipline within hospitals

There has been a considerable increase in the number of publications about psychiatric patient violence, perhaps indicating an increase in violence or an increase in staff anxiety about assault. Missing from the debate are issues of law and ward discipline and these are discussed here.