As clinicians studying outcomes of violence by patients admitted to hospitals, the benefits of the scheme described by Mann et al (Psychiatric Bulletin, March 2007, 31, 97–98) appear initially impressive. We are aware of the benefits of the collaborative approach to the investigation and management of behaviours that compromise safety in National Health Service environments (Department of Health et al, 2006) and other measures should be welcomed. However, we have three concerns about the scheme described by Mann et al.
First, we are not aware of any psychiatric unit, general or of low, medium or high security, where a uniformed police officer is stationed permanently within the premises. The presence of a dedicated police officer as described by Mann et al would only bring further stigmatisation to those with mental illness who are generally perceived by the public as inherently violent. Second, most psychiatric units admit patients for assessment or treatment and the permanent presence of a police officer on site would be unsettling for many. The benefits of this approach for managing violence in a minority of patients are unlikely to outweigh the problems for the majority of patients who have never been or who may never become violent.
Third, conflicts of interest would arise if the community officer who is funded by the hospital and managed as a police officer also functions to coordinate information for defence solicitors, the Crown Prosecution Service and the police. There is a risk of compromising the fairness of the legal process for patients who behaved violently in hospital. It is important for organisations to be mindful of their approach to managing violence in order not to further stigmatise those with mental illness.
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