Violence by psychiatric in-patients

Area of Science:

• Psychiatry
• Criminology
• Public Health

Background:

• In-patient violence presents a significant challenge in psychiatric settings.
• Understanding the trends and characteristics of patient violence is crucial for effective management and prevention.

Purpose of the Study:

• To analyze trends in in-patient violence from 1976 to 1987.
• To identify characteristics of patients who commit assaults and compare them to controls.
• To investigate the role of diagnosis, patient background, and ethnicity in violent incidents.

Main Methods:

• Analysis of a violence incident register from 1976 to 1987.
• Case note review of 137 in-patients who committed assaults in 1982.
• Comparison of violent patients with matched controls regarding demographics, diagnosis, and social factors.

Main Results:

• A progressive increase in in-patient violence was observed from 1976 to 1984, followed by a slight decline.
• Violent patients were more likely to be diagnosed with schizophrenia, exhibit delusions and hallucinations, and have a history of repeated admissions.
• Violence was often repetitive, with nurses and other patients as the most common victims.
• Afro-Caribbean patients were overrepresented, younger, more psychotic, and more likely to be compulsorily detained and treated in locked wards.

Conclusions:

• Patient violence is often repetitive and predictable based on prior behavior.
• Schizophrenia and a history of admissions are significant risk factors for in-patient violence.
• Socioeconomic factors like social isolation and unemployment were common in both violent and control groups.
• The disproportionate representation and severity of violence among Afro-Caribbean patients warrant further investigation into cultural and systemic factors.