Violence and Aggression in Psychiatric Units

Department of Psychological Medicine, University of Sydney and Canberra Hospital, Woden, New South Wales, Australia.
Psychiatric Services (Impact Factor: 2.41). 12/1998; 49(11):1452-7. DOI: 10.1176/ps.49.11.1452
Source: PubMed

ABSTRACT To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored.
Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values.
A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence.
Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.

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    • "serious and 78% are directed towards nursing staff (Owen et al. 1998). Additional evidence also points to a particular subset of individuals perpetrating this violence. "
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    ABSTRACT: Though only engaged in by a minority of sufferers, self-harm and violence can nevertheless occur within the context of a variety of mental illnesses, from personality disorder to affective disorders, to schizophrenia and other psychoses. Violence to the self (both with and without suicidal intent) and others are not uncommon occurrences on psychiatric wards. This paper explores the utilisation of a new mindfulness centred therapeutic protocol based on acceptance and commitment therapy for the management of self-harm and violence. The protocol was piloted on three patients with a history of high levels of violence to self or others on a psychiatric intensive care unit in London. An outline of acceptance and commitment therapy is provided, together with a detailed description of the protocol for the intervention itself, and some of the outcomes achieved. Recommendations for further adaptations, studies and clinical trials are considered.
    Journal of Psychiatric Intensive Care 08/2013; 9(02). DOI:10.1017/S1742646412000258
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    • "However, despite the fact that the main purpose of psychiatric institutions is to provide a stable environment to facilitate the treatment process so that patients’ psychotic symptoms could be reduced, nevertheless patients’ safety and wellbeing are threatened by violence from patients on inpatient psychiatric wards [52,53]. Nijman and his associates claimed that the hospital’s environment inescapably introduces stressors on the patient. "
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    ABSTRACT: Background Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day. Method A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings. Results Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care. Conclusions The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry.
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    • "Other positive findings have been associations between higher staffing levels and amore therapeutic wards (Moos, 1972); intensive staffing and lower lengths of stay (Becker, 1969); and lower rates of violent incidents (Chou et al., 2002; Lanza et al., 1994). However other research has found no connection between staff/patient ratios and outcomes (Ellsworth et al., 1979); more staff and more violence (Owen et al., 1998); and more staff and increased interaction between them, rather than between staff and patients (Sandford et al., 1990). Finally, in a study utlising 22 wards, although high staffing levels were associated with lower readmission rates, substantially better predictions of care outcomes could be made when the amount of attention patients received from staff was taken into account (Coleman and Paul, 2001). "
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