HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Related articles in BJP Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Abderhalden, C. Articles by Fischer, J. E. PubMed PubMed Citation Articles by Abderhalden, C. Articles by Fischer, J. E.

Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

Nursing and Social Education Research Unit, University of Bern Psychiatric Services, Berne, Switzerland

Ian Needham, PhD, MNSc

Clinic for Forensic Psychiatry, Centre of Psychiatry Rheinau, Rheinau, Switzerland

Theo Dassen, PhD

Department of Nursing Science, Humboldt University, Berlin, Germany

Ruud Halfens, PhD

Maastricht University, Maastricht, The Netherlands

Hans-Joachim Haug, MD

University of Zurich and Psychiatric Hospital Schloessli, Oetwil am See, Switzerland

Joachim E. Fischer, MD, MSc

Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Germany

Correspondence: Christoph Abderhalden, Nursing and Social Education Research Unit, University Bern Psychiatric Services, Bolligenstrasse 111, CH-3000 Berne 60, Switzerland. Email: Abderhalden{at}puk.unibe.ch

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care.

Aims

To assess whether such risk assessments decrease the incidence of violence and coercion.

Method

A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients.

Results

Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease.

Conclusions

Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.

Related articles in BJP:

From the Editor’s desk

Peter Tyrer
BJP 2008 193: 90. [Full Text]  

Highlights of this issue

Sukhwinder S. Shergill
BJP 2008 193: A3. [Full Text]