Number Of Assaults Research Articles

The Accidental Pirate: Reassessing the Legitimacy of Counterpiracy Operations

With the collapse of central authority in the wake of the Cold War's end, Somalia became a prime example of a failed state. One of the symptoms of this state's failure has been the emergence of piracy off the Somali Coast. Sporadic incidents of piracy appeared almost immediately following Somalia's implosion in 1991. By 2006, however, a new and more organized piracy group emerged, (1) As a criminal start-up based in Somalia's Puntland region, the pirates have created a flourishing enterprise. (2) From a total of 18 incidents in 2006, there has been substantial growth in the number of piracy attacks on international shipping. In 2011, approximately 130 incidents were recorded. Another 68 assaults were committed beyond Somali territorial waters but widely ascribed to Somali piracy. (3) By any measure such figures demonstrate a serious and growing security problem off the East African Coast. Piracy, of course, presents itself as an essentially maritime problem. What, then, might be considered the relevance of this article for a journal that is ostensibly devoted to matters related to land warfare and broader security issues on terra ferma? More than might be imagined, because security problems at sea are invariably reflections of political problems on land. Perceiving an issue like Somali piracy solely in maritime terms, to be dealt with by navies or coast guards, is seeing the symptoms rather than the essence of the problem. Contemporary commentary tends to analyze Somali piracy in a nautical fashion, primarily as a discrete maritime problem. For example, author Stig Hansen looks at the issue in terms of whether or not the Somali pirates constituted a putative coast guard force? Such arguments, and others like them, focus on piracy with little mention of Somalia's internal situation, particularly its political economy, which provides a more effective framework for counterpiracy recommendations. It is this factor, as much as how to deal with the symptoms, that needs to be understood. Thus, while piracy is clearly a criminal act, a lack of appreciation within operational and planning assumptions of the domestic factors that give rise to Somali piracy risk exacerbating, rather than remedying the problem. To establish this argument, British Army doctrine--developed in Afghanistan--will be extended to an analysis and understanding of piracy. This framework will be discussed in relation to Somalia using a political economy analysis. It will, thereby, be possible to examine the broader efficacy of counterpiracy operations. Current Counterpiracy Operations The long-term success of counterpiracy operations should start with the assumption that piracy is a symptom of instability? Somali piracy is inextricably linked to the nation's long-standing conflict. Unique to Somalia is a problem of sanctuary; it is the only place where vessels and hostages are often held in situ for long periods allowing for lengthy ransom negotiations. (6) Therefore, while naval boarding operations and the capture and deportation of pirates to foreign courts can have a short-term effect, (7) clearly they are unlikely to reduce the threat of piracy in the long-term. Naval interventions against the pirates might contain the number of assaults but ultimately they have little durable deterrent value. Equally problematic are military interventions on land whether by use of Special Operations Forces raids (8) or airborne drones. (9) These operations might achieve a desired tactical impact, but experience from other conflicts, notably Afghanistan, suggests that unintended consequences in terms of collateral damage on civilian centers are always a hazard. Although land-based military interventions and maritime boarding operations may be legal, they are just as likely to be seen as illegitimate in the view of the local populace and thus be of declining utility over the longer-term. British Army Influence Operations in Afghanistan In current NATO military operations in Afghanistan, the notion of influence is a burgeoning sphere of thought. …

Análisis médico-legal de las agresiones a los profesionales sanitarios en Castilla y León (España)

IntroductionThe aim of this study was to analyse attacks on health professionals in the Community of Castilla y León (CCL) since the creation of the Aggressions Observatory in 2008. Material and methodAn observational study was performed to analyse the attacks on health professionals registered in the CCL Assault Centre between July 1, 2008 and June 30, 2009. The variables studied were: number of assaults, number of workers attacked, professions of those attacked, forms of aggression, physical aggression/different variables, complaints, judgments on how the attacks were considered a “crime of assault on public servant”, and the possible profile of the aggressor and triggering causes. ResultsIn CCL, since the implementation of the Comprehensive Plan to address the assaults, the number of attacks over two years of study has been slightly reduced by 6%. The vast majority of assaults (65%) were verbal abuse; psychiatric services are where they most frequently occurred, and the perpetrator was the patient in 70% of the time. Only 9.8% of assaults were reported. ConclusionsIn CCL healthcare workers only report serious incidents that involve injuries requiring medical attention; thus preventing the knowledge of the reality of the attacks on health professionals. Health administrations have put preventive, administrative and legal measures in place to stop these aggressions.

Sexual Violence Trends between 2004 and 2008 in South Kivu, Democratic Republic of Congo

For more than a decade, conflict in the Eastern Democratic Republic of Congo (DRC) has been claiming lives. Within that conflict, sexual violence has been used by militia groups to intimidate and punish communities, and to control territory. This study aimed to: (1) investigate overall frequency in number of Eastern DRC sexual assaults from 2004 to 2008 inclusive; (2) determine if peaks in sexual violence coincide with known military campaigns in Eastern DRC; and (3) study the types of violence and types of perpetrators as a function of time. This study was a retrospective, descriptive, registry-based evaluation of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. A total of 4,311 records were reviewed. Throughout the five-year study period, the highest number of reported sexual assaults occurred in 2004, with a steady decrease in the total number of incidents reported at Panzi Hospital from 2004 through 2008. The highest peak of reported sexual assaults coincided with a known militant attack on the city of Bukavu. A smaller sexual violence peak in April 2004 coincided with a known military clash near Bukavu. Over the five-year period, the number of sexual assaults reportedly perpetrated by armed combatants decreased by 77% (p = 0.086) and the number of assaults reportedly perpetrated by non-specified perpetrators decreased by 92% (p < 0.0001). At the same time, according to the hospital registry, the number of sexual assaults reportedly perpetrated by civilians increased 17-fold (p < 0.0001). This study was limited by its retrospective nature, by the inherent selection bias of studying only survivors presenting to Panzi Hospital, and by the use of a convenience sample within Panzi Hospital. After years of military rape in South Kivu Province, civilian adoption of sexual violence may be a growing phenomenon. If this is the case, the social mechanisms that prevent sexual violence will have to be rebuilt and sexual violence laws will have to be fully enforced to bring all perpetrators to justice. Proper rehabilitation and reintegration of ex-combatants may also be an important step towards reducing civilian rape in Eastern DRC.

Transforming the Culture of Caring

Direct care staff struggle with the decision of when to physically intervene with patients. There is a widely held belief that they are expected to place themselves in danger of harm to prevent patients from hurting themselves or others. In this acute mental health care setting, an educational program was developed, using principles of adult and transformational learning, to dispel the idea that getting hurt is part of the job. The Staying Safe program strongly discourages staff from physically intervening alone and promotes staff getting enough help and having a plan. Staff are encouraged to interact with patients in helpful ways and to respond to patient requests in ways that do not increase frustration or evoke anger. There has been a positive response to the training program, evidenced by changes in the way staff think about their jobs and a reduction in the number of assaults and injuries to staff.

Attempted Suicide, Self-Harm, and Violent Victimization among Regular Illicit Drug Users

Relationships among attempted suicide, nonsuicidal self-harm, and physical assault were examined in 400 regular users of heroin and/or psychostimulants. Twenty-eight percent had episodes of nonsuicidal self-harm, 32% had attempted suicide, and 95% had been violently assaulted. The number of suicide attempts and nonsuicidal self-harm incidents were correlated (ρ = 0.44). There were also significant correlations between the number of assaults and nonsuicidal self-harm incidents (ρ = 0.17), and suicide attempts (ρ = 0.27). The mean age onset for non-suicidal self-harm (18.9 yrs) was significantly younger than that of initial suicide (22.3 yrs). The age at initial physical assault (16.0yrs) was significantly younger than that of nonsuicidal self-harm and initial suicide attempt. Screening for all forms of violence appears warranted when determining suicide risk for this population.

Ward searches help trust reduce the number of assaults on staff

Ward searches help trust reduce the number of assaults on staff

Impact of a Mental Health Training Course for Correctional Officers on a Special Housing Unit

Impact of a Mental Health Training Course for Correctional Officers on a Special Housing Unit

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterCameron David Quanbeck M.D.Barbara E. McDermott Ph.D.Cameron David Quanbeck M.D.Search for more papers by this authorBarbara E. McDermott Ph.D.Search for more papers by this authorPublished Online:1 Sep 2007https://doi.org/10.1176/ps.2007.58.9.1227aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We think Dr. Becker makes an extremely important point. Although our report did not specifically address use of seclusion and restraint, the most common reason for their use is the management of assaultive behavior ( 1 ). Therefore, if an intervention succeeds in reducing the number of aggressive incidents committed by patients in a psychiatric facility, use of seclusion and restraint will also decrease as a natural consequence. Numerous organizations have expressed concern about the deleterious psychological effects and physical risks associated with seclusion and restraint ( 2 ). The Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations have emphasized the need to limit their use to emergency situations. In response, psychiatric facilities across the nation have made concerted efforts to reduce seclusion and restraint use, and many have succeeded. However, the actual success of these efforts should be examined closely. As Dr. Becker points out, some facilities have reported that a decrease in seclusion and restraint use has been accompanied by a corresponding increase in the number of assaults and injuries to staff. In our opinion, a successful seclusion and restraint reduction program achieves a significant decrease in the number of aggressive incidents along with a decrease in use of seclusion and restraint. Psychiatric hospital administrators must achieve a delicate balance when implementing policies that are intended to reduce use of seclusion and restraint. They must protect psychiatric patients from unnecessary or prolonged confinement in seclusion and restraints. At the same time, they must be careful that a policy is not so restrictive that clinicians are unable to justify use of seclusion and restraint when necessary to prevent injuries to staff and other patients. Staff injuries from patient assaults can exact a heavy toll in terms of physical disability, psychological damage, lost work days, and poor staff morale. Further, psychiatric patients are entitled to "safe conditions of confinement," and mental health professionals in many states have a statutory duty to protect third parties—for example, as set forth in Tarasoff ( 3 ). We believe that the most effective approach to this problem is to target the root causes of aggressive behavior rather than rely on administrative policies that seek to restrict or even ban use of seclusion and restraint ( 4 ). Although our current understanding of the causes and optimal treatment of aggressive behavior remains limited, and this lack of knowledge likely plays a role in the misuse and overuse of seclusion and restraint, staff education can have positive effects. For example, after an urban psychiatric hospital implemented a staff training program on the management of assaultive behavior and mandated weekly team meetings to discuss strategies for treating aggressive patients, a decrease in both staff injuries and the rate and duration of restraint use was observed ( 5 ). The results of our study suggest that inpatient aggression is a multifaceted problem that requires heterogeneous treatment interventions; any "one size fits all" approach will not be effective in the long term.

Service innovation: policing mental health – the St Andrew's scheme

Assaults against healthcare staff have gained increasing attention, prompting the Zero Tolerance Zone campaign in the National Health Service (NHS) (Department of Health, 1999). This advised that treatment could be withheld as a sanction, although not from ‘anyone who is mentally ill or under the influence of drugs'. More recently the NHS Security Management Service (Department of Health, 2005) found that the greatest number of assaults (over 43 000) were found in mental health and learning disability environments.

The association between domestic violence and self harm in emergency medicine patients

Aims: This study compared rates of self harm among victims of domestic assault presenting to an emergency department (ED) with those rates among other ED patients. It also explored the...

An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales

This study describes ecological associations between self-inflicted death rates and prison-level environmental indicators over the period 2000–2002 in England and Wales. The objective was to assist in the development of interventions for reducing the incidence of self-inflicted deaths in prisons in England and Wales, by identifying risk factors, including overcrowding, positive drug tests, the number of assaults, purposeful activity, offending behaviour programmes, and cost per prisoner. Poisson regression was used to estimate associations between self-inflicted death rates and these potential risk factors, controlling for different categories of prison. The annual rate of self-inflicted death during 2000–2002 was 1.14 per 1000 (95% CI 0.98 to 1.34), with no evidence for a difference in the two years. Highest rates were in the Male Local and Women's prisons at 1.86 (95% CI 1.42 to 2.26) and 2.27 (95% CI 1.35 to 3.84) per 1000 respectively. In a multivariate analysis, overcrowding, assault rate and purposeful activity were significant. In an analysis controlling also for prison category, only purposeful activity remained independently significant, as a protective factor (RR 0.57, 95% CI 0.35 to 0.92, p = 0.02) with weaker evidence for a positive association with positive drug tests (RR 1.41, 95% CI 0.96 to 2.05, p = 0.08). Despite concerns about the quality of routinely collected data and the interpretation of ecological associations, this study suggests that a higher level of purposeful activity is independently associated with lower rates of self-inflicted death, whatever the prison category. This adds support to other studies conducted at the level of the individual prisoner.

Level 3 Therapeutic Model Site

L3 is an intertribal residential school enrolling approximately 200 students in grades 5-8 from tribes in the northern Midwest. As a result of successful grant-writing which espoused Circle of Courage and Asset-Building, the school built up an impressive configuration of programs funded by a variety of sources, including a cadre of mental health professionals, and began increasingly to rely on their assessments and services. First funded by the Therapeutic Residential Model program in the 2002-2003 school year, L3 used the funding that year primarily to increase professional-level services of a psychiatrist and psychologist, and to maintain or expand programs which would otherwise have been terminated as funding from short-term sources was running out. Evaluation of this project began in January 2003, when the site was assessed and determined to be strongly oriented toward provision of Level Three, or professional-level, psychiatric and medical mental health services. The initial evaluation report identified a low retention rate and raised concerns that the presence of more than 200 staff on campus had resulted in a diffusion of responsibility, lack of consistency, and duplication or redundancy of services; that elements of the environment appeared to be detrimental to social development and emotional stability; and that an unusually high proportion of students were receiving psychiatric diagnoses and medication. The site was asked to address these issues, and additional funding was provided to bolster lower levels of triage by adding paraprofessional case managers to advocate or students and coordinate provision of services for them. Retention remained low at this site throughout the course of funding, and there were a high number of assaults and psychiatric hospitalizations compared with other sites.

Characteristics of sexual assault victims presenting to the emergency department: Analysis by race, age, timing of event, and relationship to perpetrator

Study objectives: We describe the demographic characteristics, victim-perpetrator relationship, and timing of event of patients presenting to the emergency department (ED) for evaluation and treatment after sexual assault. Methods: Data were collected as part of the Sexual Assault Nurse Examiner (SANE) program at a large, urban teaching hospital and included demographics, date and time of event, relationship to perpetrator, associated injuries, physical examination results, sexually transmitted disease testing and treatment, and follow-up results. The study was a retrospective review of the records of all patients presenting to the ED with a complaint of sexual assault between January 1 and December 31, 2002. Results: During the 1-year period, 231 patients presented to the ED with a complaint of sexual assault; 209 (90.5%) were women and 22 (9.5%) were men. The average patient age was 27.1 years (SD 11.7 years), with the median age of 24 years. There was a bimodal peak in the number of assaults per month, with February and July/August reporting the greatest number of events; the fewest events took place in September. Racial breakdown was as follows: 131 whites (40.7%), 94 blacks (56.7%), 2 Hispanics (0.9%), and 4 “other” (1.7%). White victims were more likely than blacks to be assaulted on a weekend (56.3% versus 43.3%) but were less likely to be adolescent (12.1% versus 31.5%) or to know their attacker (23.1% versus 50.8%). With increasing patient age, the percentage of those who knew their attacker decreased (48% of those Conclusion: Patients presenting to the ED for sexual assault are overwhelmingly female, relatively young, and often know the perpetrator of the event. Important differences exist between patients according to temporal factors, race, and age. Further research should attempt to ascertain the etiologies of these differences and target prevention methods, evaluation, and treatment accordingly.

Relationships of Stressors, Strain, and Anger to Caregiver Assaults

Nursing assistants (NAs) working in nursing homes are at risk for nonfatal workplace violence. The aims of this study were to describe the context in which assaults occur and to identify characteristics of the NAs related to the incidence of assaults. One hundred and thirty eight subjects participated. NAs completed a demographic and employment survey, the Occupational Stress Inventory and the State Trait Anger Expression Inventory-2, and recorded information on an Assault Log for 80 hours of work. The mean number of assaults per NA was 4.69 (range 0-67). Significant relationships were found among incidence of assaults and staffing ratios, age, occupational strain, occupational role stressors, and anger. Results provide new and useful information when planning violence prevention programs for caregivers in nursing homes.

Chemical assaults in Hong Kong: a 10-year review

The aim of this study was to assess the patients admitted to Prince of Wales Hospital Burns Unit, Hong Kong between September 1991 and August 2001 following chemical assault. A total of 2319 burns were admitted during the study period of which 19 had been subjected to chemical assault. All victims sustained a burn injury to the head and neck area and 47% of victims’ eyes were burnt. A total of 84% required surgical intervention. Where a reason for the attack was admitted most were due to relationship difficulties. This study has defined the victims of chemical assault in Hong Kong. At a time when the overall number of assaults in Hong Kong is at its lowest level for 5 years it is of concern that there appears to have been a recent increase in the number of chemical assaults in Hong Kong.

Gender, sexual harassment, workplace violence, and risk assessment:: Convergence around psychiatric staff's perceptions of personal safety

This paper reviews literature in sexual harassment, workplace violence, and risk assessment as it relates to staff in psychiatric and forensic work environments. These three areas of research overlap in their applicability to psychiatric staff in that each addresses the understanding and management of types of violence to which many staff, particularly women, are likely to be exposed while working. Employee well-being, encompassing mental and physical health, job satisfaction, and morale, has been shown to be closely tied to organizational productivity and cost. In addition, gender has been shown to be an important factor in perceptions and decision-making, and prior work has suggested that female staff often have qualitatively different experiences in traditional male workplaces such as inpatient and forensic settings. Despite these findings, research to date on psychiatric staff has typically focused only on number of assaults by patients. It has not addressed how staff's gender may impact their perceptions of personal safety and judgments of risk from patients, nor have any empirical studies been performed in naturalistic settings to investigate this issue. Given the high correlation between organizational productivity and employee well-being, it is mutually beneficial to both employers and staff to examine current understanding of how certain staff variables such as gender may influence their feelings of safety and judgments of risk from patients.

The Crowded Ward

Back to table of contents Previous article Next article LetterFull AccessThe Crowded WardShailesh Kumar, M.R.C.Psych., M.Phil., Bradley Ng, M.B.Ch.B., and Elizabeth RobinsonShailesh KumarSearch for more papers by this author, M.R.C.Psych., M.Phil., Bradley NgSearch for more papers by this author, M.B.Ch.B., and Elizabeth RobinsonSearch for more papers by this authorPublished Online:1 Nov 1999https://doi.org/10.1176/ps.50.11.1499AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We read with interest the article in the June issue entitled "Crowding and Aggression on Inpatient Psychiatric Wards," in which Nijman and Rector (1) report a modest correlation between the number of patients on two acute wards and the number of aggressive incidents. Crowding on acute psychiatric wards is a topical but underinvestigated issue. It is of concern to most mental health service providers given the global trend to reduce the number of inpatient beds on psychiatric wards.As the authors acknowledge, most studies of violence on acute inpatient units have concentrated on individual patient variables. Only a few well-designed studies have specifically examined the relationship between violence and crowding on acute units. Although an association between crowding and aggressive incidents sounds plausible, it is not supported by many studies. Lanza and associates (2) found no relationship between the percentage of occupied beds on a unit and the number of assaults, and in a recent study Hardie (3) concluded that an increase in patient density was not associated with an increase in violent incidents. Therefore Nijman and Rector's study is useful.However, because the authors did not report on the extent of patient use of the enlarged space created by opening a courtyard in one of the wards, it is difficult to draw any conclusions about the significance of the finding that the number of aggressive incidents did not decline after the courtyard was opened. If we accept that an association exists between crowding and violent behavior, then additional space must be utilized in order to reduce the number of aggressive incidents.In our view, aggressive incidents on a crowded ward may occur because of stress. Stress has been suggested as an explanation for the observed association between violence and crowding in a number of animal and human studies (4,5). Psychiatric hospitalization in itself is stressful for most patients, and this stress can be exacerbated by crowding. Crowding creates intrusions into personal space, disrupts patient and staff activities, and leads to patient frustration about being forced to socialize in a confined space. These factors may act independently or together to aggravate the stress and lower frustration tolerance, leading to aggressive incidents.The modest association Nijman and Rector found between aggressive incidents and crowding was identified by correlation analysis. The use of correlation is offered as an explanation of why a causal relationship between crowding and aggressive incidents could not be established. A weekly occupancy rate was used, and we assume a weekly incident rate was calculated. One problem with the use of correlation is the daily population changes. Regression analysis might have been more a more useful statistical approach because the outcome variables were dichotomous; that is, they indicated whether there was an incident or not. A regression model with crowding, ward, and time as explanatory variables, defined as before or after the ward was enlarged, might have been a more powerful analysis.Dr. Kumar and Dr. Ng are affiliated with Rotorua Hospital in Rotorua, New Zealand. Ms. Robinson is with the department of community medicine in the Auckland School of Medicine in Auckland, New Zealand.

The effect of multiple childhood sexual assaults on mock-jurors' perceptions of repressed memories.

The effect of multiple childhood sexual assaults on the believability of a repressed memory of the assault was assessed using mock jurors. Participants read a fictional civil trial summary about a child sexual assault case presented in one of three reporting conditions: (a) immediate condition-the alleged victim testified immediately after the assault(s); (b) repressed condition-the alleged victim reported the assault(s) 20 years later, after remembering it/them for the first time; or (c) no-repressed condition-the alleged victim reported the assault(s) 20 years later, but the memory of the assault(s) had been present for those years. The number of assaults was either one or 30. The results showed that for all reporting conditions 30 alleged assaults led to relatively more decisions for the plaintiff than the defendant, and greater believability of the plaintiff. The increases in decisions rendered and believability were also generally true for the immediate condition compared to when there was a delay in reporting. The results are discussed in terms of mock jurors' perceptions of child sexual assault, both those reported immediately and those reported after many years.

Éléments pour une sociologie de l'insécurité

Ingredients for a Sociology of Insecurity. While the number of assaults has been more or less stable for several years, the sociology of victimisation is changing. The explosion of violence, linked with entry into consumer society, has coincided with a decrease in surveillance of public spaces. Moreover, the problem of petty crime has not been dealt with in any depth. A show was made, in the 70s, of introducing a system of juvenile justice and in attempting integration through the labour market. With the crisis came a radical modification of the data. Integration via employment became difficult and petty crime, comprising thefts and minor assaults, generated an enormous insecurity complex. In response to a growing sense of exclusion the insecurity which is present in certain problematic districts may be partially explained by a desire to affirm an identity. In the face of this phenomenon, the state has shown its capacity to adapt.

Staff's Experiences with Patients' Assaults in a Norwegian Psychiatric University Hospital: A Pilot Study

This pilot study addressed the problem of patients' assaults on staff at a Norwegian psychiatric university hospital. The questionnaire-based study had a retrospective design, and involved a random sample of staff (n = 85). It revealed that 100% of the nursing staff and 60.9% of the therapists (doctors, psychologists, and social workers) had been physically assaulted by patients at least once during their careers at the hospital. Most of the assaults did not result in sick leave, and could as such be classified as not serious. There were no significant differences in the number of assaults on male and female staff or between staff in the emergency, intermediary, rehabilitation and psycho-geriatric wards. The staff responded that they believed male patients were more violent and threatening than female patients, although a majority had been assaulted more frequently by female than by male patients. Assault was the reason most frequently given for physically restraining patients, and most of the staff did not believe that physically restraining patients reduced their chances of recovery. The study suggests that patients' assaults on staff in Norwegian psychiatric hospitals is an important problem, which needs further attention.