Violence and aggression in psychiatric units

Area of Science:

• Psychiatry
• Criminology
• Healthcare Management

Background:

• Aggressive and violent behaviors pose significant risks in acute psychiatric inpatient settings.
• Understanding the frequency, types, and contributing factors of these incidents is crucial for improving patient and staff safety.

Purpose of the Study:

• To determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings.
• To explore the interactions between staffing, patient mix, and the rates of these behaviors.

Main Methods:

• Prospective data collection on violent incidents across five adult acute psychiatric units in Sydney, Australia.
• Incidents were ranked on an 8-level scale, with staff also reporting on staffing levels and patient mix weekly.
• Poisson regression analysis was employed to calculate relative rates, confidence intervals, and p-values.

Main Results:

• Over seven months, 1,289 violent incidents were recorded, with 58% deemed serious and 78% directed at nursing staff.
• Increased risk of violence was associated with more nursing staff, more non-nursing staff on leave, patients prone to violence, disorientation, compulsory detention, and seclusion.
• Decreased risk was linked to younger staff, nursing staff absenteeism, higher admission rates, and patients with substance abuse or physical illness.

Conclusions:

• Violent incidents are a common and serious issue in psychiatric settings.
• The study suggests that incidents are likely underreported, and the severity of an incident does not ensure its documentation.