Violence and Restrictive Practices Reduced by Hospital Relocation

Ward design is increasingly recognized as influencing the treatment of psychiatric inpatients. However, evidence on how improved structural surroundings affect aggression and restrictive practices in forensic psychiatry is limited. To our knowledge, no studies have focused on the effect of improved treatment facilities on aggressive behavior and the prescription of restrictive practices among forensic psychiatric inpatients.

This study aims to explore whether improved architectural design reduces aggression and prescription of restrictive practices in a population of forensic psychiatric inpatients.

This retrospective, observational, and longitudinal study included a follow-up 2 years prior and 2 years post relocating the Department of Forensic Psychiatry at Aarhus University Hospital Psychiatry (DFP-AUHP) from an old hospital building to new and purpose-built psychiatric facilities. We included all patients admitted to DFP-AUHP during the study period; 230 unique patients before and 196 unique patients after the relocation. We compared aggression as measured by the Brøset Violence Checklist (BVC) and prescription of restrictive practices prior to and after the intervention. Data were drawn from the Business Intelligence data portal, which routinely stores data from the Electronic Patient File. Statistical analyses were conducted to explore patient demographics, aggression, and the prescription of restrictive practices.

Overall, restrictive practices were more than halved among the included population of forensic psychiatric patients after the relocation (548 to 246, p value: < 0.001). Additionally, the total daily mean BVC, an indicator of aggressive behavior, was significantly lower post-relocation (from 0.40 (95% CI: 0.39-0.42) to 0.27 (95% CI: 0.26-0.28), p value: < 0.001). Both summative data and underlying time trends evidence the results.

Our study suggests a significant reduction in aggressive behavior and restrictive practices following the relocation. The study contributes to understanding how environmental changes can relate to patient outcomes and may be relevant for the design and renovation of psychiatric hospital facilities.

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