Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres

The disturbed behaviour of acute in-patients can have serious consequences, and methods of management are contentious and vary between countries. Little is known about this variation and its relationship to the characteristics of in-patient populations.

The aim of this study was to compare rates and patterns of disturbed behaviours and containment methods in acute psychiatric wards in three centres in the United Kingdom, Italy and Greece.

A retrospective survey of medical and nursing records (n=838) at seven hospitals for the first 2 weeks of patients' admissions was done using a structured data collection tool.

Nearly all types of disruptive behaviour varied by centre, with rates being generally higher in the UK and lowest in Italy. Specific relationships between different behaviours were replicated across all three centres. Ethnic minority patients were more likely to be subject to containment measures in all centres, even when their behaviours did not differ from the majority. Rates of containment method use were only partially related to the frequency of disturbed behaviour.

More research is required to discover the efficacy of varying containment methods, with a view to minimising their use. Gross international and inter-hospital variation demands large samples rather than single site studies. Clinicians need to reflect upon containment rates that may be, in some places, excessive and incorrectly targeted.