Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-15T01:18:23.002Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: Patient assaults, staff assaults, and repeatedly violent patients

Published online by Cambridge University Press:  04 May 2015

Charles Broderick ,
Allen Azizian ,
Rebecca Kornbluh  and
Katherine Warburton
Charles Broderick*
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Allen Azizian
Affiliation:
Coalinga State Hospital, Coalinga, California, USA Department of Criminology, California State University, Fresno, California, USA
Rebecca Kornbluh
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Katherine Warburton
Affiliation:
California Department of State Hospitals, Sacramento, California, USA Division of Psychiatry and the Law, University of California, Davis, California, USA
*
*Address for correspondence: Charles Broderick, PhD, California Department of State Hospitals, Clinical Operations Division, 1600 9th Street, Room 400, Sacramento, CA 95814, USA. (Email: charles.broderick@dsh.ca.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

We examined physical violence in a large, multihospital state psychiatric system during 2011–2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety.

Method

Acts of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011–2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios.

Results

Overall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization.

Discussion

Implications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.

Keywords

Aggressionassaultforensichospitalinpatientmental illnesspsychiatricschizoaffectiveschizophreniaviolence
Type
Original Research
Information
CNS Spectrums , Volume 20 , Special Issue 3: Violence in the Psychiatric Setting , June 2015 , pp. 319 - 330
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors wish to thank our Data Management Office, and especially Ms. Pat Young, for her support and dedication in providing us with the data necessary to complete our work. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the California Department of State Hospitals.

References

1. Swanson, JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and Mental Disorder: Developments in Risk Assessment. Chicago: University of Chicago Press; 1994: 101–136.Google Scholar
2. Swanson, JW, Swartz, MS, Van Dorn, RA, et al. A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry. 2006; 63(5): 490–499.Google Scholar
3. Swanson, JW, McGinty, EE, Fazel, S, Mays, VM. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol. In press. DOI: 10.1016/j.annepidem.2014.03.004.Google Scholar
4. McNiel, DE, Binder, RL, Greenfield, TK. Predictors of violence in civilly committed acute psychiatric patients. Am J Psychiatry. 1988; 145(8): 965–970.Google Scholar
5. Convit, A, Isay, D, Otis, D, Volavka, J. Characteristicsof repeatedly assaultive psychiatric inpatients. Hosp Community Psychiatry. 1990; 41(10): 1112–1115.Google Scholar
6. Linhorst, DM, Scott, LP. Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients. J Interpers Violence. 2004; 19(8): 857–874.Google Scholar
7. Abderhalden, C, Needham, I, Dassen, T, Halfens, R, Fischer, JE, Haug, HJ. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland. Clin Pract Epidemiol Ment Health. 2007; 3: 30.Google Scholar
8. Hoptman, MJ, Yates, KF, Patalinjug, MB, Wack, RC, Convit, A. Clinical prediction of assaultive behavior among male psychiatric patients at a maximum-security forensic facility. Psychiatr Serv. 1999; 50(11): 1461–1466.Google Scholar
9. Soliman, AE, Reza, H. Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatr Serv. 2001; 52(1): 75–80.Google Scholar
10. Raja, M, Azzoni, A. Hostility and violence of acute psychiatric inpatients. Clin Pract Epidemiol Ment Health. 2005; 1(1): 11.Google Scholar
11. Dietz, PE, Rada, RT. Battery incidents and batterers in a maximum security hospital. Arch Gen Psychiatry. 1982; 39(1): 31–34.Google Scholar
12. Noble, P, Rodger, S. Violence by psychiatric in-patients. Br J Psychiatry. 1989; 155(3): 384–390.Google Scholar
13. Bowers, L, Stewart, D, Papadopoulos, C, et al. Inpatient violence and aggression: a literature. Report from the Conflict and Containment Reduction Research Programme. London: Kings College; 2011. http://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevAgg.pdf. Last accessed October 23, 2014.Google Scholar
14. Parks, J, Radke, AQ, Haupt, MB. The Vital Role of State Psychiatric Hospitals. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council: Alexandria, VA; 2014. http://www.nasmhpd.org/publications/The%20Vital%20Role%20of%20State%20Psychiatric%20HospitalsTechnical%20Report_July_2014.pdf. Last accessed October 23, 2014.Google Scholar
15. Blow, FC, Barry, KL, Copeland, LA, McCormick, RA, Lehmann, LS, Ullman, E. Repeated assaults by patients in VA hospital and clinic settings. Psychiatr Serv. 1999; 50(3): 390–394.CrossRefGoogle ScholarPubMed
16. Novaco, R. Anger as a risk factor for violence among the mentally disordered. In: Monahan J, Steadman HJ, eds. Violence and Mental Disorder: Developments in Risk Assessment. Chicago, IL: University of Chicago Press; 1994: 21–60.Google Scholar
17. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
18. R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing: Vienna, Austria. http://www.R-project.org. Last accessed October 23, 2014.Google Scholar
19. Binder, RL, McNiel, DE. The relationship of gender to violent behavior in acutely disturbed psychiatric patients. J Clin Psychiatry. 1990; 51(3): 110–114.Google Scholar
20. Monahan, J, Steadman, HJ, Silver, E, et al. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York: Oxford University Press; 2001.Google Scholar
21. Stokman, CLJ, Heiber, P. Incidents in hospitalized forensic patients. Victimology. 1980; 5(2–4): 175–192.Google Scholar
22. Kennedy, MG. Relationship between psychiatric diagnosis and patient aggression. Issues Ment Health Nurs. 1993; 14(3): 263–273.Google Scholar
23. Daffern, M, Howells, K. The prediction of imminent aggression and self-harm in personality disordered patients of a high security hospital using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression. International Journal of Forensic Mental Health. 2007; 6(2): 137–143.Google Scholar
24. Rachlin, S. On the need for a closed ward in an open hospital: the psychiatric intensive-care unit. Hosp Community Psychiatry. 1973; 24(12): 829–833.Google Scholar
25. Barlow, K, Grenyer, B, Ilkiw-Lavalle, O. Prevalence and precipitants of aggression in psychiatric inpatient units. Aust N Z J Psychiatry. 2000; 34(6): 967–974.Google Scholar
26. Lussier, P, Verdun-Jones, S, Deslauriers-Varin, N, Nicholls, T, Brink, J. Chronic violent patients in an inpatient psychiatric hospital: prevalence, description, and identification. Criminal Justice and Behavior. 2009; 37(1): 5–28.Google Scholar
27. Abderhalden, C, Needham, I, Dassen, T, Halfens, R, Haug, HJ, Fischer, JE. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry. 2008; 193(1): 44–50.Google Scholar
28. Vaaler, AE, Iversen, VC, Morken, G, Fløvig, JC, Palmstierna, T, Linaker, OM. Short-term prediction of threatening and violent behaviour in an acute psychiatric intensive care unit based on patient and environment characteristics. BMC Psychiatry. 2011; 11(1): 44–50.Google Scholar