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Management of psychiatric in-patient violence: patient ethnicity and use of medication, restraint and seclusion

Denis Hill Unit, South London and Maudsley NHS Trust, Institute of Psychiatry, London

Sophia Rabe-Hesketh, PhD

Department of Biostatistics and Computing, Institute of Psychiatry, London

George Szmukler, FRCPsych

Institute of Psychiatry, London

Correspondence: Professor Gisli H. Gudjonsson, Department of Psychology (PO 78), Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail: spjtghg{at}iop.kcl.ac.uk

Declaration of interest None.

Background Significant ethnic differences have been found previously on a forensic unit in the management of psychiatric patients after a violent incident.

Aims To study the management of violent incidents on all general wards in a large psychiatric hospital in South London. The main question is whether there are differences in the management of Black patients involved in violent incidents compared with White patients and, if so, what are the factors leading to it?

Method All recorded violent incidents (1515 in total) on 14 general wards over three years (1994, 1996, 1998) were analysed using mixed logistic regression to estimate the odds ratio that the corresponding management decision (emergency medication, physical restraint, seclusion) was taken for Black patients compared with White patients after controlling for covariates and unobserved heterogeneity between subjects.

Results Black patients were more likely than White patients to be given emergency medication and to be secluded after a violent incident, but not to be physically restrained. However, differences disappeared when the odds ratios were adjusted for other variables.

Conclusions Racial ‘stereotyping’ was unlikely to have played a major direct role in determining nurses’ responses.

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