What events precede violent incidents in psychiatric hospitals?

Abstract

The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals. Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an 'untoward incident database'. From eyewitness accounts, 921 incidents (92%) could be related to one of 15 categories of antecedent involving characteristics of the patient, or of the hospital regime, or interactions with other individuals. Overall, the most common antecedents involved patients who were generally agitated or disturbed (286), restrictions on patients associated with the routine hospital regime (192) or provocation by other patients, relatives or visitors (175). Incidents arising from staff members initiating contact with patients were very rare (7). Twenty-one patients were involved in 10 or more incidents, including 19 (90%) who were detained under the Mental Health Act. These patients were more likely to commit assaults after certain antecedents (self-harm, absconding or arson) which were serious incidents in themselves. Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.