Defensive practice in mental health.
OBJECTIVE
This study aimed to assess the extent of defensive clinical practice by psychiatrists and psychiatric nurses in a New Zealand Mental Health Service.


METHODS
An anonymous questionnaire survey, addressing perceptions of a variety of defensive practices, was sent to all psychiatrists and psychiatric nurses working in acute clinical settings in the publically funded mental health service in Dunedin, New Zealand.


RESULTS
Defensive practice is perceived as widespread in psychiatric settings. In particular, practices such as questioning patients about their safety, admissions to hospital, and delayed discharge from hospital were often perceived as occurring for defensive purposes. Psychiatric nurses were more likely than psychiatrists to perceive such practices as defensive.


CONCLUSIONS
Defensive practice is common in mental health. This is despite New Zealand's no-fault compensation scheme, and so presumably results from concerns other than the risk of financial liability. There may be particular pressures in mental health to practice defensively.
Mullen
Richard
R
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand. richard.mullen@stonebow.otago.ac.nz
Admiraal
Anita
A
Trevena
Judy
J
D003675:Defensive Medicine / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D009520:New Zealand; D011568:Psychiatric Nursing / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D011570:Psychiatry / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data