Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T07:16:52.591Z Has data issue: false hasContentIssue false
  • English
  • Français

What Events Precede Violent Incidents in Psychiatric Hospitals?

Published online by Cambridge University Press:  02 January 2018

Georgia Powell ,
Woody Caan  and
Michael Crowe
Georgia Powell
Affiliation:
Maudsley Hospital, London
Woody Caan*
Affiliation:
Maudsley Hospital, London
Michael Crowe
Affiliation:
Maudsley Hospital, London
*
Dr A. W. Caan, Maudsley Hospital, Denmark Hill, London SE5 8AZ
Get access Rights & Permissions [Opens in a new window]

Extract

Background

The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals.

Method

Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an ‘untoward incident database’.

Results

From eyewitness accounts, 921 incidents (92%) could be related to one of 15 categories of antecedent involving characteristics of the patient, or of the hospital regime, or interactions with other individuals. Overall, the most common antecedents involved patients who were generally agitated or disturbed (286), restrictions on patients associated with the routine hospital regime (192) or provocation by other patients, relatives or visitors (175). Incidents arising from staff members initiating contact with patients were very rare (7). Twenty-one patients were involved in 10 or more incidents, including 19 (90%) who were detained under the Mental Health Act. These patients were more likely to commit assaults after certain antecedents (self-harm, absconding or arson) which were serious incidents in themselves.

Conclusions

Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 165 , Issue 1 , July 1994 , pp. 107 - 112
Copyright
Copyright © Royal College of Psychiatrists, 1994 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aquilina, C. (1991) Violence by psychiatric inpatients. Medicine, Science and the Law, 31, 306–312.CrossRefGoogle Scholar
Blomhoff, S., Seim, S. & Friis, S. (1990) Can prediction of violence among psychiatric inpatients be improved? Hospital and Community Psychiatry, 41, 1112–1115.Google Scholar
Caan, W. & Waylett, C. (1993) Welfare workers reaching out across the poverty gap. Psychiatric Bulletin, 17, 564–565.Google Scholar
Davis, D. L. & Boster, L. H. (1986) The violent psychiatric inpatient. American Journal of Forensic Psychiatry, 4, 3–17.Google Scholar
Health and Safety Executive (1992) New Health and Safety at Work Regulations. Sheffield: Health and Safety Executive.Google Scholar
Hinrichs, R. (1988) Indirect forms of iatrogenic violence in clinical psychiatry. Psychiatrische Praxis, 15, 165–170.Google ScholarPubMed
Hodge, J. E. (1992) New thoughts on psychopathy and addiction. Journal of Mental Health, 1, 179–181.CrossRefGoogle Scholar
Humphreys, M. S., Johnstone, E. C., MacMillan, J. F. & Taylor, P. J. (1992) Dangerous behaviour preceding first admissions for schizophrenia. British Journal of Psychiatry, 161, 501–505.Google Scholar
ICS Ltd (for CLINICS software), 1 Bear Court, Daneshill, Basingstoke, Hants RG24 0QT.Google Scholar
James, D. V., Fineberg, N. A., Shah, A. K. & Priest, R. G. (1990) An increase in violence on an acute psychiatric ward: a study of associated factors. British Journal of Psychiatry, 156, 846–852.Google Scholar
Lancet (1988) Violence, Nursing and Inpatient Psychiatry. Correspondence. Lancet, i, 940.Google Scholar
Lavender, A. (1987) The effects of nurses changing from uniforms to everyday clothes on a psychiatric rehabilitation ward. British Journal of Medical Psychology, 60, 189–199.Google Scholar
Leiba, P. A. (1992) Learning from incidents of violence in health care. An investigation of “case reports” as a basis for staff development and organisational change. Nurse Education Today, 12, 116–121.CrossRefGoogle ScholarPubMed
Noble, P. & Roger, S. (1989) Violence by psychiatric in-patients. British Journal of Psychiatry, 155, 384–390.Google Scholar
Plutchik, R. & Van Praag, H. M. (1990) A self report measure of violence risk: II. Comprehensive Psychiatry, 31, 450–456.Google Scholar
Powell, O. (1992) Auditing untoward incidents in the Bethlem Royal & Maudsley Hospitals. In Making Audit Work for Mental Health Services (Lecture abstracts). London: Institute of Psychiatry.Google Scholar
Prins, H. (1990) Some observations on the supervision of dangerous offender patients. British Journal of Psychiatry, 156, 157–162.Google Scholar
Russell, D. (1992) Standard 5b. In Mental Health Nursing Practice Standards and Audit. London: Bethlem Royal & Maudsley Hospital Special Health Authority.Google Scholar
Schnieden, V. & Marren-Bell, U. (1992) Teaching of aggression management. Psychiatric Bulletin, 16, 447–448.CrossRefGoogle Scholar
Southwark Community Health Council (1993) Sexual violence and abuse in hospital wards. Seminar Report. London: Southwark CHC.Google Scholar
Stark, C. & Kidd, B. (1992) Violence management special interest group. Psychiatric Bulletin, 16, 556.Google Scholar
Swanson, J. W., Holzer, C. E., Ganju, V. K. & Jono, R. T. (1990) Violence and psychiatric disorder in the community: evidence from the Epidemiological Catchment Area surveys. Hospital and Community Psychiatry, 41, 761–770.Google ScholarPubMed
Tarbuck, P. (1992) Ethical standards and human rights. Nursing Standard, 28 October 1992, pp. 27–30.Google Scholar
Taylor, P. J. (1992) Dangerous behaviour preceding first admissions for schizophrenia. British Journal of Psychiatry, 161, 501–505.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.