Situational variables and institutional violence: a systematic review of the literature.
ABSTRACT The impact of violence on institutions is not hard to discern: staff and patients are physically injured and may become psychologically disturbed, property is destroyed, and regimes and programs are disrupted and thereby impoverished. Furthermore, violent individuals are not only incarcerated for longer but are held in more expensive and more restrictive conditions. In order to manage institutional violence, risk factors need to be identified. Research directed at understanding institutional violence has tended to focus on person-centered explanations. However, human behavior does not occur in a vacuum of internal drives and motivations; situational factors are also relevant. A focus on situational risk factors may provide an additional means for managing institutional violence. The primary aim of this systematic review was to examine research that measured the impact of situational factors on institutional violence. The relationships among physical, verbal and/or sexual face-to-face violence and situational factors in prisons and closed psychiatric settings were reviewed. A descriptive and in-depth analysis of previous research findings was carried out. Findings indicated that a range of situational factors may impact on institutional violence. Methodological issues that influence the confidence that can be placed on these findings are considered. The implications of the findings are outlined.
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ABSTRACT: Purpose ‐ The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care. Design/methodology/approach ‐ The paper uses a retrospective survey of routinely collected incident data from one 207-bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability. Findings ‐ In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other-directed aggression, 31.8 per cent self-harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self-harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway. Research limitations/implications ‐ Incidents, especially those of lower severity, can be under-reported in routine practice. Information about incident severity was limited. Practical implications ‐ Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility. Originality/value ‐ This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.Journal of Forensic Practice. 01/2013; 15(3).
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ABSTRACT: Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness. This prospective validation study involved 4440 DASA:YV ratings of mentally ill adolescents in a secure hospital. At 24 hours post-assessment, the nursing staff documented whether patients had behaved aggressively: physically, verbally or towards property. Predictive accuracy was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The DASA:YV significantly predicted any imminent aggression (AUC = 0.754). Additional youth-specific items conferred a greater predictive yield, as compared to adult-derived items (p = 0.014). It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence. © The Royal Australian and New Zealand College of Psychiatrists 2014.Australasian Psychiatry 12/2014; · 0.56 Impact Factor
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ABSTRACT: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure.Clinical practice and epidemiology in mental health : CP & EMH. 01/2014; 10:94-102.