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An Increase in Violence on an Acute Psychiatric Ward

A Study of Associated Factors

Published online by Cambridge University Press:  02 January 2018

David V. James
Affiliation:
The Royal Free Hospital, Hampstead
Naomi A. Fineberg
Affiliation:
Academic Department of Psychiatry, St Mary's Hospital, Paddington
Ajit K. Shah
Affiliation:
Academic Department of Psychiatry, St Mary's Hospital, Paddington
Robert G. Priest*
Affiliation:
Academic Department of Psychiatry, St Mary's Hospital, Praed Street, London W2
*
Correspondence

Abstract

The increase in violent incidents on an acute psychiatric ward over a 15–month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1990 

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References

Adler, W. N., Kreeger, C. & Ziegler, P. (1983) Patient violence in a private psychiatric ward. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Aiken, G. J. M. (1984) Assaults on staff in a locked ward: prediction and consequences. Medicine, Science, and the Law, 24, 199207.CrossRefGoogle Scholar
Armond, A. D. (1982) Violence in the semi-secure ward of a psychiatric hospital. Medicine, Science and the Law, 22, 203209.CrossRefGoogle Scholar
Bouras, N., Trauer, T. & Watson, J. P. (1982a) Ward environment and disturbed behaviour. Psychological Medicine, 12, 309319.CrossRefGoogle ScholarPubMed
Bouras, N., Traver, T. & Watson, J. P. (1982b) Effects of staff changes on psychiatric patients. Journal of Nervous and Mental Disease, 170, 107110.CrossRefGoogle ScholarPubMed
Brailspord, D. S. & Stevenson, J. (1973) Factors related to violent and unpredictable behaviour in psychiatric hospitals, 18, 911.Google Scholar
Conn, L. M. & Lion, J. R. (1983) Assaults in a university hospital. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune and Stratton.Google Scholar
Crammer, J. L. (1984) The special characteristics of suicide in hospital in-patients. British Journal of Psychiatry, 145, 459463.CrossRefGoogle ScholarPubMed
Department Of The Environment (1983) Inner Cities Directorate: Information Note No. 2. Urban Deprivation. London: Department of the Environment.Google Scholar
Department Of Health And Social Security (1988) Violence to Staff Report of the DHSS Advisory Committee on Violence to Staff. London: DHSS.Google Scholar
Depp, F. C. (1983) Assaults in a public mental hospital. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Dietz, P. E. & Rada, R. T. (1982) Battery incidents and batterers in a maximum security hospital. Archives of General Psychiatry, 39, 3134.CrossRefGoogle Scholar
Dietz, P. E. & Rada, R. T. (1983) Interpersonal violence in forensic facilities. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Drink water, J. (1982) Violence in psychiatric hospitals. In Developments in the Study of Criminal Behaviour, Vol. 2. Violence (ed. P. Feldman). Colchester: John Wiley & Sons.Google Scholar
Edwards, J. G. & Reid, W. H. (1983) Violence in psychiatric facilities in Europe and the United States. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Ekblom, B. (1970) Acts of Violence by Patients in Mental Hospitals. Uppsala: Scandinavian University Books.Google Scholar
Fisher, N. (1988) The fear of assault. Bethlem and Maudsley Gazette, 35, 1, 3840.Google Scholar
Folkard, S. (1960) Aggressive behaviour in relation to open wards in a mental hospital. Mental Hygiene, 44, 155161.Google Scholar
Fottrell, E., Bewley, T. & Squizzoni, M. (1978) A study of aggressive and violent behaviour among a group of psychiatric in-patients. Medicine, Science, and the Law, 18, 6669.CrossRefGoogle ScholarPubMed
Fottrell, E. (1980) A study of violent behaviour among patients in psychiatric hospitals. British Journal of Psychiatry, 136, 216221.CrossRefGoogle ScholarPubMed
Gibbons, R. D. & Davis, J. M. (1984) The price of beer and the salaries of priests: analysis and display of longitudinal psychiatric data. Archives of General Psychiatry, 41, 11831184.CrossRefGoogle Scholar
Haller, R. M. & Deluty, R. H. (1988) Assaults on staff by psychiatric in-patients: a critical review. British Journal of Psychiatry, 152, 174179.CrossRefGoogle ScholarPubMed
Her Majesty's Stationery Office (1985) Criminal Statistics: England & Wales. London: HMSO.Google Scholar
Hodgkinson, P. E., Mcivor, L. & Phillips, M. (1985) Patient assaults on staff in a psychiatric hospital: a two-year retrospective study. Medicine, Science, and the Law, 25, 288294.CrossRefGoogle Scholar
Infantino, J. A. & Musingo, S.-Y. (1985) Assaults and injuries among staff with and without training in aggression control techniques. Hospital & Community Psychiatry, 36, 13121314.Google ScholarPubMed
Ionno, J. A. (1983) A prospective study of assaultive behaviour in female psychiatric in-patients. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal, 286, 17051709.CrossRefGoogle ScholarPubMed
Kalogerakis, M. G. (1971) The assaultive psychiatric patient. Psychiatric Quarterly, 45, 372381.CrossRefGoogle ScholarPubMed
Langley, G. E. & Bayatti, N. N. (1984) Suicides in Exe Vale Hospital 1972–1981. British Journal of Psychiatry, 145, 463467.CrossRefGoogle ScholarPubMed
Levy, P. & Hartocollis, P. (1976) Nursing aids and patient violence. American Journal of Psychiatry, 133, 429431.Google Scholar
Lion, J. R., Snyder, W. & Merrill, G. L. (1981) Under-reporting of assaults on staff in a state hospital. Hospital & Community Psychiatry, 32, 497498.Google Scholar
Martin, J. P. (1984) Hospitals in Trouble. Oxford: Blackwell.Google ScholarPubMed
McNiel, D. E., Binder, R. L. & Greenfield, T. K. (1988) Predictors of violence in civilly committed acute psychiatric patients. American Journal of Psychiatry, 145, 965970.Google ScholarPubMed
Melbin, M. (1969) Behaviour rhythms in mental hospitals. American Journal of Sociology, 74, 650655.Google ScholarPubMed
Morgan, H. G. & Priest, P. (1984) Assessment of suicide risk in psychiatric in-patients. British Journal of Psychiatry, 145, 467472.CrossRefGoogle ScholarPubMed
National Health Service Health Advisory Service (1988) Report on Services Provided for Mentally Ill People. Paddington and North Kensington Health Authority and the Social Services Departments of the City of Westminster and the Royal Borough of Kensington and Chelsea. London: DHSS.Google Scholar
Packham, H. (1978) Violence: managing the violent patient. Nursing Mirror, June 22, 1719.Google Scholar
Pearson, M., Wilmot, E. & Padi, M. (1986) A study of violent behaviour among in-patients in a psychiatric hospital. British Journal of Psychiatry, 149, 232235.CrossRefGoogle ScholarPubMed
Ruben, I., Wolkon, G. & Yamamoto, J. (1980) Physical attacks on psychiatric residents by patients. Journal of Nervous and Mental Disease, 168, 243245.CrossRefGoogle ScholarPubMed
Shader, R. I., Jackson, A. H., Harmatz, J. S., et al (1977) Patterns of violent behaviour among schizophrenic in-patients. Diseases of the Nervous System, 38, 1316.Google Scholar
Shah, A. K. & Piachaud, J. (1988) Violence and inpatient psychiatry. Lancet, i, 940.Google Scholar
Soloff, P. H. (1983) Seclusion and restraint. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Tardiff, K. (1983) A survey of assault by chronic patients in a state hospital system. In Assaults within Psychiatric Facilities (eds J. R. Lion & W. H. Reid). New York: Grune & Stratton.Google Scholar
Tardiff, K. (1984) Characteristics of assaultive patients in private hospitals. American Journal of Psychiatry, 141, 12321235.Google ScholarPubMed
Tardiff, K. & Sweillam, A. (1979) Age and assaultive behaviour in mental patients. Hospital and Community Psychiatry, 30, 709711.Google ScholarPubMed
Tardiff, K. & Sweillam, A. (1982) Assaultive behaviour among chronic psychiatric in-patients. American Journal of Psychiatry, 139, 212215.Google Scholar
Watson, J. P. & Bouras, N. (1988) Psychiatric ward environments and their effects on patients. In Recent Advances in Clinical Psychiatry, Vol 6 (ed K. Granvilie-Grossman). Edinburgh: Churchill Livingstone.Google Scholar
Werner, P. D., Yesavage, J. A., Becker, J. M., et al (1983) Hostile words and assaultive behaviour on an acute inpatient psychiatric unit. Journal of Nervous and Mental Disease, 171, 385387.CrossRefGoogle Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD–9), Geneva: WHO.Google Scholar
Yates, J. (1981) Staff-patient ratios and hospital enquiries. Nursing Times, 9 December, 21432145.Google Scholar
Yesavage, J. A. (1982) Inpatient violence and the schizophrenic patient: an inverse correlation between danger-related events and neuroleptic levels. Biological Psychiatry, 17, 13311337.Google ScholarPubMed
Yesavage, J. A. (1983) Bipolar illness: correlates of dangerous in-patient behaviour. British Journal of Psychiatry, 143, 554557.CrossRefGoogle Scholar
Yesavage, J. A. (1984) Correlates of dangerous behaviour by schizophrenics in hospital. Journal of Psychiatric Research, 18, 225231.CrossRefGoogle ScholarPubMed
Yesavage, J. A., Werner, P., Becker, J., et al (1981) In-patient evaluation of aggression in psychiatric patients. Journal of Nervous and Mental Disease, 169, 299302.CrossRefGoogle Scholar
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