Management of psychiatric in-patient violence: patient ethnicity and use of medication, restraint and seclusion.
BACKGROUND
Significant ethnic differences have been found previously on a forensic unit in the management of psychiatric patients after a violent incident.


OBJECTIVE
To study the management of violent incidents on all general wards in a large psychiatric hospital in South London. The main question is whether there are differences in the management of Black patients involved in violent incidents compared with White patients and, if so, what are the factors leading to it?


METHODS
All recorded violent incidents (1515 in total) on 14 general wards over three years (1994, 1996, 1998) were analysed using mixed logistic regression to estimate the odds ratio that the corresponding management decision (emergency medication, physical restraint, seclusion) was taken for Black patients compared with White patients after controlling for covariates and unobserved heterogeneity between subjects.


RESULTS
Black patients were more likely than White patients to be given emergency medication and to be secluded after a violent incident, but not to be physically restrained. However, differences disappeared when the odds ratios were adjusted for other variables.


CONCLUSIONS
Racial 'stereotyping' was unlikely to have played a major direct role in determining nurses' responses.
Denis Hill Unit, South London and Maudsley NHS Trust, Institute of Psychiatry, London. spjtghg@iop.kcl.ac.uk
Gisli H
GH
Gudjonsson
Sophia
S
Rabe-Hesketh
George
G
Szmukler
D000328:Adult; D044383:Black People / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D016017:Odds Ratio; D010356:Patient Isolation; D011369:Professional-Patient Relations; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D012149:Restraint, Physical; D014754:Violence / Q000208:ethnology* / Q000517:prevention & control; D044465:White People / Q000523:psychology
D011619:Psychotropic Drugs