What events precede violent incidents in psychiatric hospitals?
BACKGROUND
The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals.


METHODS
Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an 'untoward incident database'.


RESULTS
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.


CONCLUSIONS
Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.
Maudsley Hospital, London.
G
G
Powell
W
W
Caan
M
M
Crowe
D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003134:Commitment of Persons with Psychiatric Disorders; D003142:Communication; D003617:Dangerous Behavior; D003631:Day Care, Medical / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D006801:Humans; D007256:Information Systems; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010348:Patient Care Team; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data*; D012637:Security Measures; D012737:Sex Factors; D012931:Social Environment; D014754:Violence