© 2004 The Royal College of Psychiatrists
Correspondence |
Analysis of psychiatric in-patient violence
West London Mental Health NHS Trust, John Conolly Wing, Uxbridge Road, Southall UB1 3EU, UK
There are two major problems with the study of Gudjonsson et al (2004) which render interpretation of the results problematic. First, violent incidents were identified from untoward incident reporting forms. Formally evaluated scales measuring violent behaviour were not used. It is well recognised that nursing staff may underreport violent behaviour on incident forms (Shah et al, 1991). Moreover, there is no mention of incident forms other than those for untoward incidents. In some hospitals there are different types of incident forms (including that for untoward incidents) depending how the incident is classified. Furthermore, no data are provided on the exact number of staff completing these forms and reliability between different raters in the reporting of violent incidents. The second concern is with the definition of ethnicity. The authors provide no information on how ethnicity was defined. It was simply ascertained from the record of ethnicity on the untoward incident form. There are many problems with the definition of ethnicity. Unless ethnicity is clearly defined and all those completing the incident forms use the same definition, this is likely to introduce bias in the findings. Again, no data are provided on how many staff completed the incident forms and the reliability in the reporting of ethnicity between different staff members. These issues are important because findings on psychiatric issues and ethnicity are often considered to be controversial and emotive to all sectors of society.
REFERENCES
- Gudjonsson, G. H., Rabe-Hesketh, S. & Szmukler, G.
(2004) Management of psychiatric in-patient violence: patient
ethnicity and use of medication, restraint and seclusion. British
Journal of Psychiatry, 184, 258
-262.
[Abstract/Free Full Text] - Shah, A. K., Fineberg, N. A. & James, D. V. (1991) Violence among psychiatric inpatients. Acta Psychiatrica Scandinavica, 84, 304 -309.
Authors’ reply
Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill,london SE5 8AF, UK
The two main concerns of Dr Shah relate to the standard hospital incident form used in the study and lack of definition of ethnicity. We accept the potential methodological problems associated with the use and retrospective analyses of routine ‘untoward’ incident data.
However, we do have two specific comments on Dr Shah’s letter. First, our study was a large-scale investigation involving 1515 ‘untoward’ incidents on 14 general wards within our trust over a 3-year period. In view of the large number of incidents analysed we believe it is unlikely that unrecorded incidents or inaccurately recorded ethnic background of some patients would have significantly influenced the findings. In the statistical analyses the patients were only classified into two groups: ‘White’ and ‘Black’ (i.e. ‘African–Caribbean’ and ‘African’). Second, the main findings were broadly similar to those of a previous large-scale study of 165 medium secure unit patients at the Bethlem Royal Hospital (Gudjonsson et al, 2000). In that study the ethnic background of the patients was obtained from the patient register rather than from the incident forms (Gudjonsson et al, 1999).
REFERENCES
- Gudjonsson, G. H., Rabe-Hesketh, S. & Wilson, C. (1999) Violent incidents on a medium secure unit over a 17-year period.Journal of Forensic Psychiatry, 10, 249 -263.
- Gudjonsson, G. H., Rabe-Hesketh, S. & Wilson, C. (2000) Violent incidents in a psychiatric hospital. The target of assault and the management of incidents. Journal of Forensic Psychiatry, 11, 105 -118.
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