Reducing violence on a secure ward

Ann Mortimer

doi:10.1192/pb.19.10.605

Abstract

Prediction of in-patient psychiatric violence is difficult: longitudinal appraisal during environmental change may identify Influential factors. Incidents on a secure ward fell substantially in number and severity over 31 months during which staff were trained in control and restraint techniques (CAR) and a monthly audit of incidents was carried out. A few patients caused many incidents. Women were disproportionately violent: both sexes preferred a victim of the same gender. Most incidents occurred in clusters by the same patient. Perceived antecedents were patients' psychosis, inadequate CAR and other staff. Increasing C&R staff was the only factor associated with reducing violence. Patients attacked each other rather than nurses as violence decreased.

Highlights

Prediction of in-patient psychiatric violence is difficult: longitudinal appraisal during environmental change may identify influential factors
Violence is the end product of innumerable factors: upbringing, personality, age, sex, dthiaegsniotusaist,ioncurorfetnhte smyommpetonmt. aCtolliongicyallayn,d'rufliensalloyf thumb' tend to be followed, with extra risks perceived in previously violent patients, ifyoung, male and psychotic
I report a study of violence over 31 months, during which all ward staff were trained in control and restraint techniques (C&R) and a monthly audit of incidents was carried out

Summary

Ann Mortimer

Prediction of in-patient psychiatric violence is difficult: longitudinal appraisal during environmental change may identify influential factors. Incidents on a secure ward fell substantially in number and severity over 31 months during which staff were trained in control and restraint techniques (C&R) and a monthly audit of incidents was carried out. Perceived antecedents were patients' psychosis, inadequate C&R and other staff. At least one in ten psychiatric patients assaults staff (DHSS, 1988). Many studies describe antecedents and correlates of patient violence. The inherent variability of patients may be allowed for by studying violence levels over time in the context of environmental change. I report a study of violence over 31 months, during which all ward staff were trained in control and restraint techniques (C&R) and a monthly audit of incidents was carried out

The study

Findings

When started