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PubMed1994

Violent incidents in a psychiatric intensive care unit.

A prospective study was undertaken of physical assaults over six months in a newly opened psychiatric intensive care unit. There were 58 admissions of 48 patients, and 37 assaults, three against other patients, and 34 against nursing and medical staff. Features which correlated with committing assault were a criminal record and previous drug abuse. Assaults occurred most frequently during the week, at times when staff were actively involved with the patients.

Adolescent↗
PubMed1994

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. METHOD: 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.

Adult↗
PubMed1994

A national audit of new long-stay psychiatric patients. I: Method and description of the cohort.

BACKGROUND: This first report of a national audit of new long-stay (NLS) psychiatric patients conducted in 1992 describes the survey method and characteristics of the cohort. METHOD: Psychiatrists from 59 UK mental health services returned data on 905 patients, aged 18-64 on admission, who had been in hospital for between six months and three years. RESULTS: Two particular sub-groups were observed. Younger NLS patients (aged 18-34) were predominantly single men with schizophrenia; 43% of these had a history of serious violence, dangerous behaviour or admission to a Special Hospital and over one-third were formally detained. Older NLS patients (aged 55-67) were predominantly married or previously married women, more often with a diagnosis of affective disorder or dementia and with poor personal and social functioning; over half were at moderate or severe risk of non-deliberate self-harm. CONCLUSIONS: Despite the continued policy of bed closures and focus on care in the community, some patients admitted recently to psychiatric units in the UK still have protracted hospital stays.

Adolescent↗
PubMed1995

Prediction of dangerous behaviour in male erotomania.

BACKGROUND: New cases of erotomania in men, plus cases from the literature, were analysed to explore any association between erotomania and dangerousness, and to identify possible predictors. METHOD: Files at two in-patient facilities were examined to determine the presence of DSM-III-R delusional disorder, erotomanic type. The sample (13 cases) was divided into dangerous and benign groups on the basis of serious antisocial behaviour directly related to erotomanic delusions. These cases were combined with all reports of erotomania in men (16 cases), found in the English language psychiatric literature, to allow for statistical analysis. RESULTS: Two factors, multiple delusional objects (P < 0.0005) and serious antisocial behaviour unrelated to the delusions (P < 0.05), were found to be significantly associated with dangerousness. Using a combination of these two variables it was possible to predict dangerousness with an accuracy of 88.9% (weighted prediction accuracy or 'hit rate'). We identified no false negatives but three false positives. CONCLUSIONS: The presence of multiple objects, and a history of serious antisocial behaviour unrelated to the erotomanic delusions, are useful predictors of dangerous behaviour in men with erotomania.

Adult↗
PubMed1996

Severe personality disorders. Treatment issues and selection for in-patient psychotherapy.

BACKGROUND: Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs. METHOD: Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience. RESULTS: Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral. CONCLUSIONS: General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.

Combined Modality Therapy↗
PubMed1997

Needs assessment for mentally disordered offenders and others requiring similar services. Theoretical issues and methodological framework.

BACKGROUND: The government has highlighted the service needs of mentally disordered offenders (MDOs) and has introduced policies which have driven MDO needs assessment. METHOD: Based on a literature review and a national survey of agencies likely to be conducting needs assessment, the paper reviews government policy regarding MDO needs assessment and examines the particular problems of conducting needs assessment for MDOs. RESULTS: A methodological framework for MDO needs assessment is presented, and different needs assessment approaches are discussed. The methodological and practical limitations of conducting MDO needs assessment are emphasised, as is the role of subjective judgement in both research design and interpretation. CONCLUSIONS: Needs assessment is value-laden. Also, no single needs assessment approach can address all the issues of importance to purchasers and providers. Substituting the term 'perspectives on need' for the term needs assessment would help to reflect the lack of a single 'truth' about need and emphasise the role of subjective political judgement in designing and interpreting research on 'need'.

Dangerous Behavior↗
PubMed2004

Epidemiology of involuntary placement of mentally ill people across the European Union.

BACKGROUND: Despite the tendency for harmonisation of strategies for mental health care delivery, rules and regulations for involuntary placement or treatment of mentally ill persons still differ remarkably internationally. Rapid European integration and other political developments require valid and reliable international overviews, sound studies and profound analyses of this controversial issue. AIMS: To give an overview of compulsory admission data from official sources across the European Union (EU). METHOD: Data on the legal frameworks for involuntary placement or treatment of people with mental illness and their outcomes were provided and assessed by experts from all EU member states. RESULTS: Total frequencies of admission and compulsory admission rates vary remarkably across the EU. Variation hints at the influence of differences in legal frameworks or procedures. Time series suggest an overall tendency towards more or less stable quotas in most member states. CONCLUSIONS: Further research is greatly needed in this field. Common international health reporting standards are essential to the compilation of basic data.

Commitment of Persons with Psychiatric Disorders↗
PubMed2004

Dangerous and endangered youth: social structures and determinants of violence.

Structural violence is violence that is permissible, even encouraged. It refers to the invisible social machinery of inequality that reproduces social relations of exclusion and marginalization via ideologies, stigmas, and dangerous discourses (such as "youth violence" itself) attendant to race, class, sex, and other invidious distinctions. Structural violence "naturalizes" poverty, sickness, hunger, and premature death, erasing their social and political origins so that they are taken for granted and no one is held accountable except the poor themselves. Structural violence also refers to the ease with which humans are capable of reducing the socially vulnerable (even those from their own class and community) into expendable non-persons, thus allowing the licence--even the duty--to kill them. I exemplify this through two ethnographic critical case studies: the operation of a virulent death squad in Northeast Brazil that mobilized the support of ordinary people in an almost genocidal attack against Afro-Brazilian street kids and young "marginals"; and the uneasy truce with, and incomplete integration of "dangerous and endangered" youth still living in squatter camps and shack communities of urban South Africa.

Adolescent↗
PubMed1991

Hide-and-seek or show-and-tell? Emerging issues of informed consent.

This article reviews key philosophical and legal underpinnings of mental health professionals' obligation to obtain informed consent from consumers of their services. The basic components of informed consent are described, and strategies for clinically and ethically appropriate methods of obtaining informed consent are discussed. Emerging issues in informed consent involving duty to assess and protect against client dangerousness, obligations to third parties, and issues of deception are considered as well. The article proposes that part of the process of obtaining informed consent is the cultivation of a treatment environment that emphasizes beneficence and client autonomy.

Altruism↗