TY - JOUR
T1 - Aggression in specialist secure and forensic inpatient mental health care : incidence across care pathways
AU - Dickens, Geoff
AU - Picchioni, Marco
AU - Long, Clive
PY - 2013
Y1 - 2013
N2 - Purpose: The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care. Design/methodology/approach: The paper uses a retrospective survey of routinely collected incident data from one 207-bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability. Findings: In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other-directed aggression, 31.8 per cent self-harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self-harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway. Research limitations/implications: Incidents, especially those of lower severity, can be under-reported in routine practice. Information about incident severity was limited. Practical implications: Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility. Originality/value: This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.
AB - Purpose: The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care. Design/methodology/approach: The paper uses a retrospective survey of routinely collected incident data from one 207-bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability. Findings: In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other-directed aggression, 31.8 per cent self-harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self-harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway. Research limitations/implications: Incidents, especially those of lower severity, can be under-reported in routine practice. Information about incident severity was limited. Practical implications: Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility. Originality/value: This paper extends current knowledge about how incidents of violence and aggression differ across secure settings.
KW - aggression
KW - mental health services
KW - psychiatric hospitals
KW - self, mutilation
KW - violence
UR - http://handle.westernsydney.edu.au:8081/1959.7/uws:46903
U2 - 10.1108/JFP-09-2012-0017
DO - 10.1108/JFP-09-2012-0017
M3 - Article
SN - 2050-8794
VL - 15
SP - 206
EP - 217
JO - Journal of Forensic Practice
JF - Journal of Forensic Practice
IS - 3
ER -