Violence In Psychiatry Research Articles

Coercion and aggression in psychiatry: the individual psychological dimension of aggressive and coercive acts by therapists

There is a long paternalistic tradition in psychiatry and medicine in general. With a view on that, the law has been changed in order to strengthen patients' autonomy and personal rights and also to reduce coercion and violence. Nowadays, medical and therapeutic actions have to take place within stricter and narrower boundaries and the balance between therapists' provision of care and patients' rights of autonomy had to be renegotiated. In the present paper organisational, structural and legal factors which foster the emergence of coercion and violence in psychiatric treatment will be reported along with factors lying within therapists themselves. Individual factors of therapists that foster the emergence of coercion and violence are amongst other factors suggested by partly tremendous differences in prevalence rates of coercion and violence between hospitals and regions. Aggression coming from therapists can be frequently observed in clinical practice and are also reported in the literature. However, this issue nevertheless is a kind of taboo amongst therapists. Aggression, coercion and violence coming from therapists can be explained by their personality, attitudes, level of training and knowledge and also by their individual biography and involvement in cultures and traditions of clinical teams and hospitals. Despite changes in law the prevalence of coercion and violence in psychiatry is still too high. Amongst other factors, also individual factors of therapists can be made responsible for this situation.

Differences in male and female nurses' responses to physical assault by psychiatric patients: a supplemental finding of a mixed-methods study.

In one segment of a multifactor study conducted in 2011 at five psychiatric sites in three counties of Long Island, New York, 110 nurses were interviewed about their experiences with physical assault by psychiatric patients. Marked differences were identified between the male and female nurse participants who were assaulted. Women expressed feelings of inadequacy and questioned their competence. They felt blamed by administration and sometimes even colleagues. In addition, many did not report the incident for fear of reprisal. Women believed that violence was to be expected, and they considered it part of the job. On the other hand, men did not question their competency. They blamed external factors, such as poor staffing or unsafe design of the unit, or they stated that the patient was inadequately medicated and impossible to control. The male nurses did not feel blamed for the incident. All but one male nurse formally reported the incidents. They believed that violence in psychiatry is to be expected but should not be considered part of the job. These findings may be explained by Weiner's Attribution Theory.

Good (or bad) vibrations: clinical intuition in violence risk assessment

SummaryAssessment and management of the risk of violence in psychiatry inevitably and appropriately draws on emotionally laden ‘intuitive’ modes of thought, as well as deliberative analytic thinking. This article discusses the concept of ‘intuition’ and proposes a brief set of guidelines, derived from work by the cognitive psychologist Robin Hogarth, by which intuitive thinking may be applied by clinicians when undertaking risk assessment work. The guidelines are: consider the learning structure relevant to the risk assessment task; use your own emotions as a source of data; impose ‘circuit breakers' such as cost–benefit analyses and validated structured risk assessment tools; and use a narrative approach to develop formulations. The guidelines are intended to provide a framework for ongoing reflective practice in assessing and managing risk.

Violence against care workers in psychiatry: Is prosecution justified?

The number of (severe) violent incidents against staff caused by psychiatric inpatients is high. Victims often do not report these incidents to the police, because of various reasons. But if they do report these incidents, the judicial authorities are often reluctant in prosecuting and convicting these patients. The central question in this article is ‘in which cases is it appropriate to prosecute assaultive psychiatric patients?’ In order to identify the influential factors in the decision in respectively reporting, prosecuting and convicting psychiatric patients who assault staff, a literature review has been performed. On the basis of this literature it is advised to report and investigate a case when the incident resulted in severe injury, the incident is a sexual offence, or when a patient repetitively causes violent incidents. Moreover, it appears that, although large amount of studies has been published on violence in psychiatry, the prosecution of violent psychiatric patients has hardly received any attention in the international literature. Empirical studies on this subject are suggested, in order to develop a uniform policy, which is embraced by all parties involved.

Institucionalno nasilje u psihijatriji

The introduction presents aspects of aggressive behavior of the mentally ill in various conditions and depending on the diagnosed psychic disorder. Social aspects of involuntary hospitalization of the mentally ill are presented in detail, in epidemiological, clinical psychiatric and general social context. The conclusion points to important considerations and measures to be taken by the society in order to reduce institutional violence in psychiatry.

Patientengerechte Aggressionsbewältigung in der Psychiatrie

Violence, aggression, and patient assaults result in a considerable number of job-related accidents in psychiatry. We describe a patient-oriented training program for managing aggression and violence in psychiatry. Ratings by 335 training participants indicate high to very high acceptance. In addition, ratings in the questionnaire for the study subjects' beliefs about competence and control suggest a statistically significant increase in active behavior and internal locus of control in 31 subjects. No significant changes were observed in the waiting-list control group. Our results suggest that a patient-oriented training program for the management of aggression and violence in psychiatry can have high acceptance and lead to lasting changes in beliefs about competence and control, resulting in an increased internal locus of control.

De-escalation in mental health care: a review of non-physical conflict management techniques

Until present, conflict management in mental health care relies much on physical techniques. Not surprisingly, research literature on interpersonal de-escalation in medical sciences, social sciences and psychology is rare. This presentation reviews rules and techniques that are applicable to mental health care [1]. Based on empirical data and theoretical models on the emergence of violence in psychiatry, following issues are discussed in detail: stress and anger management of staff, basic de-escalation rules, body language, facial expressions, verbal interventions. It is concluded that de-escalation in mental health care is still in its beginnings.

Le thérapeute face au comportement agressif

All therapists working in psychiatry will have to deal orte day with an aggressive patient. Besides, the probability of such an encounter is more and more to be expected in view of the increase of violence in psychiatry. Witnessing this, the author set about researching the subject. He presents in this article a review of literature on this theme (aetiologic hypothesis, statistics, etc.) and illustrates his ideas with specific examples. He ends his article by wishing that a better understanding of this problem may help the therapists to improve treatment of these patients and to prevent their act of violence.

P03.367 Violence in psychiatry. A study on an accreditation program

P03.367 Violence in psychiatry. A study on an accreditation program

Violence in psychiatry: is there a European agenda?

Violence in psychiatry: is there a European agenda?