Categorization of aggressive acts committed by chronically assaultive state hospital patients
ABSTRACT This study examined factors motivating inpatient aggression in a sample of chronically assaultive state hospital patients.
Inpatients who had committed three or more assaults over a one-year period were identified by using an incident report database. Aggressive episodes were categorized as impulsive, organized, or psychotic by using a procedure for classifying assaultive acts based on record review. Each assault type was further subcategorized. The relationship between assault type, victim (staff or patient), and legal status of the assaulter was also assessed.
A total of 839 assaults committed by 88 chronically aggressive patients were reviewed. Although most patients had a primary psychotic disorder, the most common type of assault was impulsive (54%), rather than psychotic or organized. Staff were most often victimized by impulsive assaults in situations involving attempts to change a patient's unwanted behavior and refusal of a patient request. Organized and psychotic assaults occurred less frequently (29% and 17%, respectively) and were more likely to target other patients. Organized assaults were most often motivated by a desire to seek revenge. Psychotic assaults were most often committed by an assailant acting under the influence of paranoid ideations. Civilly committed patients were overrepresented in the sample. Criminally committed patients committed more acts of organized aggression, although this finding did not reach significance.
These findings indicate that assaultive behavior among state hospital inpatients is complex and heterogeneous. Because each type of assault requires a different management approach, characterizing aggressive behavior may be important in determining which institutional programs and treatment-plan interventions to implement when addressing inpatient aggression.
- SourceAvailable from: Mirjam E van Leeuwen[Show abstract] [Hide abstract]
ABSTRACT: The number of (severe) violent incidents against staff caused by psychiatric inpatients is high. Victims often do not report these incidents to the police, because of various reasons. But if they do report these incidents, the judicial authorities are often reluctant in prosecuting and convicting these patients. The central question in this article is 'in which cases is it appropriate to prosecute assaultive psychiatric patients?' In order to identify the influential factors in the decision in respectively reporting, prosecuting and convicting psychiatric patients who assault staff, a literature review has been performed. On the basis of this literature it is advised to report and investigate a case when the incident resulted in severe injury, the incident is a sexual offence, or when a patient repetitively causes violent incidents. Moreover, it appears that, although large amount of studies has been published on violence in psychiatry, the prosecution of violent psychiatric patients has hardly received any attention in the international literature. Empirical studies on this subject are suggested, in order to develop a uniform policy, which is embraced by all parties involved.International Journal of Law and Psychiatry 09/2011; 34(5):317-23. DOI:10.1016/j.ijlp.2011.08.011 · 1.19 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The link between positive outcomes and qualified nurse staffing levels is well established for general hospitals. Evidence on staffing levels and outcomes for mental health nursing is more sparse, contradictory and complicated by the day to day allocation of staff resources to wards with more seriously ill patients. To assess whether rises in staffing numbers precede or follow levels of adverse incidents on the wards of psychiatric hospitals. Time series analysis of the relationship between shift to shift changes over a six month period in total conflict incidents (aggression, self-harm, absconding, drug/alcohol use, medication refusal), total containment incidents (pro re nata medication, special observation, manual restraint, show of force, time out, seclusion, coerced intramuscular medication) and nurse staffing levels. 32 acute psychiatric wards in England. At the end of every shift, nurses on the participating wards completed a checklist reporting the numbers of conflict and containment incidents, and the numbers of nursing staff on duty. Regular qualified nurse staffing levels in the preceding shifts were positively associated with raised conflict and containment levels. Conflict and containment levels in preceding shifts were not associated with nurse staffing levels. Results support the interpretation that raised qualified nurse staffing levels lead to small increases in risks of adverse incidents, whereas adverse incidents do not lead to consequent increases in staff. These results may be explicable in terms of the power held and exerted by psychiatric nurses in relation to patients.International journal of nursing studies 08/2011; 49(1):15-20. DOI:10.1016/j.ijnurstu.2011.07.005 · 2.25 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Actuarial violence risk assessments, many of which include the construct of psychopathy, have been shown to be superior to clinical judgment in the prediction of long-term risk of community violence and recidivism. While these instruments initially appeared to provide similarly accurate judgments of risk of institutional aggression, recent research has indicated that such assessments may be less robust in this setting. One explanation may lie in the types of aggression most frequently observed in each setting. Impulsive (or reactive/affective) is the type of physical aggression most commonly exhibited in psychiatric facilities. This research examines the relationship between risk assessments and aggression in an inpatient forensic setting, with such aggression categorized as impulsive, predatory or psychotic aggression. Consistent with previous research, impulsive aggression was the most frequent type observed (58%). Anger (as measured by the Novaco Anger Scale) and clinical issues (as measured by the HCR-20) were most associated with impulsive aggression, with AUC values of .73 and .71 respectively. In contrast, anger and psychopathy (as measured by the PCL-R) were more associated with predatory aggression, with AUC values of .95 and .84 respectively. Psychotic symptoms were highly associated with psychotically motivated aggression (AUC = .90). These results suggest that traditional violence risk assessments may have limited utility in predicting aggression in an institutional setting and that psychiatric symptoms and heightened affect are more relevant. Copyright © 2008 John Wiley & Sons, Ltd.Behavioral Sciences & the Law 11/2008; 26(6):759 - 777. DOI:10.1002/bsl.842 · 0.96 Impact Factor