The journal of mental health administration

, Volume 21, Issue 1, pp 24–31 | Cite as

Risk factors for psychiatric inpatient assaults on staff

  • Raymond B. FlanneryJr.
  • M. Annette Hanson
  • Walter E. Penk
Regular Articles


The risk of psychiatric patient assaults on staff members is increasing yearly, with resultant increases in employee victim suffering, medical expense, and lost productivity. Traditionally considered a clinician responsibility, the management of patient violence also has important administrative implications. This article presents a review of the risk factors associated with violence that includes the characteristics of patients who assault but adds the characteristics of employee victims of such assaults as well as contextual variables. Additional data from a two-year study of a peer-help crisis intervention program for employee victims of patient assaults are included. The mental health administrative implications of this approach are outlined.


Community Psychiatry Stress Management Intervention Mental Health Administrator Crisis Counseling Patient Violence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Blair DT: Assaultive behavior: Does provocation begin in the front office?Journal of Social Nursing 1991; 29: 21–26.Google Scholar
  2. 2.
    Lipscomb JA, Love CC: Violence toward healthcare workers: An emerging occupational hazard.American Association of Hospital Nurses Journal 1992; 40:219–228.Google Scholar
  3. 3.
    Bloom JD: The character of danger in psychiatric practice: Are the mentally ill dangerous?.Bulletin of the American Academy of Psychiatric Law 1989; 17:241–255.Google Scholar
  4. 4.
    Davis S: Violence in psychiatric inpatients: A review.Hospital and Community Psychiatry 1991; 42:585–590.PubMedGoogle Scholar
  5. 5.
    Lusk SL: Violence in the work place.American Association of Hospital Nurses Journal 1992; 40:212–213.Google Scholar
  6. 6.
    Reid WH, Bollinger MF, Edwards JG: Serious assaults by inpatients.Psychosomatics 1989; 30: 54–56.PubMedGoogle Scholar
  7. 7.
    Flannery RB, Jr., Fulton P, Tausch J, et al.: A program to help staff cope with psychological sequelae of assaults by patients.Hospital and Community Psychiatry 1991; 42:935–938.PubMedGoogle Scholar
  8. 8.
    Caldwell ME: The incidence of PTSD among staff victims of patient violence.Hospital and Community Psychiatry 1992; 43:838–839.PubMedGoogle Scholar
  9. 9.
    Monahan J: Mental disorder and violent behavior.American Psychologist 1992; 47:511–521.PubMedCrossRefGoogle Scholar
  10. 10.
    Hunter M, Carmel H: The cost of staff injuries from inpatient violence.Hospital and Community Psychiatry 1992; 43:586–588.PubMedGoogle Scholar
  11. 11.
    Convit A, Jaeger J, Lin SP, et al.: Predicting assaultiveness in psychiatric inpatients: A pilot study.Hospital and Community Psychiatry 1988; 39:429–434.PubMedGoogle Scholar
  12. 12.
    Klassen O, O’Connor WA: A prospective study of predictors of violence in adult male mental health admissions.Law and Human Behavior 1988; 12:143–148.CrossRefGoogle Scholar
  13. 13.
    Morrison EF: Theoretical modeling to predict violence in hospitalized psychiatric patients.Research on Nursing Health 1989; 12:31–40.Google Scholar
  14. 14.
    Shah AK, Fineberg NA, James DV: Violence among psychiatric inpatients.Acta Psychiatrica Scandinavica 1991; 84:305–309.PubMedGoogle Scholar
  15. 15.
    Tardiff K: A model for the short-term prediction of violence potential. In: Prizer D, Crowner M (Eds.):Current Approaches to the Prediction of Violence. Washington, DC: American Psychiatric Press, 1989, pp. 3–12.Google Scholar
  16. 16.
    Koss MP, Harvey MR:The Rape Victim: Clinical and Community Approaches. Rev. ed. Newbury Park, CA: Sage, 1991, pp. 43–47.Google Scholar
  17. 17.
    Cooper AJ, Mendonca JD: A prospective study of patient assaults on nurses in provicial psychiatric hospital in Canada.Acta Psychiatrica Scandinavica 1991; 84:163–166.PubMedGoogle Scholar
  18. 18.
    Fottrell E: A study of violent behavior among patients in psychiatric hospitals.British Journal of Psychiatry 1980; 136:216–221.PubMedGoogle Scholar
  19. 19.
    Jones MK: Patient violence: Report of 200 incidents.Journal of Psychosocial Nursing 1985; 23:12–17.Google Scholar
  20. 20.
    Kalogerakis MG: The assaultive psychiatric patient.Psychiatric Quarterly 1971; 45:372–381.PubMedCrossRefGoogle Scholar
  21. 21.
    Lanza ML: The reactions of nursing staff to physical assault by a patient.Hospital and Community Psychiatry 1983; 34:44–47.PubMedGoogle Scholar
  22. 22.
    Lee HK, Villar O, Juthani N, et al.: Characteristics and behavior of patients involved in psychiatric ward incidents.Hospital and Community Psychiatry 1989; 40:1295–1297.PubMedGoogle Scholar
  23. 23.
    Soloff PH, Gutheil TG, Wexler DB: Seclusion and restraint in 1985: A review and update.Hospital and Community Psychiatry 1985; 36:652–657.PubMedGoogle Scholar
  24. 24.
    Tardiff KJ: A survey of psychiatrists in Boston and their work with violent patients.American Journal of Psychiatry 1974; 131:1008–1011.PubMedGoogle Scholar
  25. 25.
    Tardiff K: Characteristics of assaultive patients in private hospitals.American Journal of Psychiatry 1984; 141: 1232–1235.PubMedGoogle Scholar
  26. 26.
    Tardiff K, Sweillam A: Assaultive behavior among chronic inpatients.American Journal of Psychiatry 1982; 139:212–215.PubMedGoogle Scholar
  27. 27.
    Way BB, Banks SM: Use of seclusion and restraint in public psychiatric hospitals: Patient characteristics and facility effects.Hospital and Community Psychiatry 1990; 41:75–81.PubMedGoogle Scholar
  28. 28.
    Lion JR, Snyder W, Merrill GL: Underreporting of assaults on staff in a state hospital.Hospital and Community Psychiatry 1981; 32:497–498.PubMedGoogle Scholar
  29. 29.
    Carmel H, Hunter M: Compliance with training in managing assaultive behavior and injuries from inpatient violence.Hospital and Community Psychiatry 1980; 41:558–560.Google Scholar
  30. 30.
    Lanza ML, Kayne HL, Hicks C, et al.: Nursing staff characteristics related to patient assault.Issues in Mental Health Nursing 1991; 12:253–265.PubMedGoogle Scholar
  31. 31.
    Dietz PE, Rada RT: Battery incidents and batterers in a maximum security hospital.Archives of General Psychiatry 1982; 39:31–34.PubMedGoogle Scholar
  32. 32.
    Edwards JG, Jones D, Reid WH, et al.: Physical assaults in a psychiatric unit of a general hospital.American Journal of Psychiatry 1988; 145:1568–1571.PubMedGoogle Scholar
  33. 33.
    Hanson RH, Balk JA: Areplication study of staff injuries in a state hospitalHospital and Community Psychiatry 1992; 43:836–837.PubMedGoogle Scholar
  34. 34.
    Harris GT, Rice ME: Staff injuries sustained during altercations with psychiatric patients.Journal of Interpersonal Violence 1986; 1:193–211.Google Scholar
  35. 35.
    Carmel H, Tanke ED, Yesavage JA: Physician staffing and patient violence.Bulletin of the American Academy of Psychiatry and the Law 1991; 19:1.Google Scholar
  36. 36.
    Phillips P, Nasr SJ: Seclusion and restraint and prediction of violence.American Journal of Psychiatry 1983; 140:229–232.PubMedGoogle Scholar
  37. 37.
    Levy P, Hartocollis P: Nursing aides and patient violence.American Journal of Psychiatry 1976; 133: 429–435.PubMedGoogle Scholar
  38. 38.
    Norris D:Violence Against Social Workers: The Implications for Practice with the University of Sussex National Research Study by Carol Kedmond. London: Jessica Kingsley Publisher, 1990, pp. 24–40.Google Scholar
  39. 39.
    Christenfeld R, Wagner J, Pastva G, et al.: How physical settings affect chronic mental patients.Psychiatric Quarterly 1989; 60:253–264.PubMedCrossRefGoogle Scholar
  40. 40.
    Rosenbaum M: Violence in psychiatric wards: Role of the lax milieu.General Hospital Psychiatry 1991; 13: 115–121.PubMedCrossRefGoogle Scholar
  41. 41.
    Katz P, Kirkland FP: Violence and social structure on mental hospital wards.Psychiatry 1990; 53: 262–277.PubMedGoogle Scholar
  42. 42.
    Tanke EG, Yesavage JA: Characteristics of assaultive patients who do and do not provide visible cues of potential violence.American Journal of Psychiatry 1985; 142:1409–1413.PubMedGoogle Scholar
  43. 43.
    Caldwell JB, Naismith LJ: Violent incidents in special hospitals.British Journal of Psychiatry 1989; 154:270.CrossRefGoogle Scholar
  44. 44.
    Flannery RB, Jr., Penk WE: Cyclical variations in psychiatric patient-to-staff assaults: Preliminary inquiry.Psychological Reports 1993; 72:642.PubMedGoogle Scholar
  45. 45.
    Flannery RB, Jr., Hanson MA, Penk WE, et al.: The Assaulted Staff Action Program (ASAP): An approach to coping with the aftermath of duty-related violence. In: Puryear-Keita G (Ed.):Job Stress Interventions: Current Practice and Future Directions. Washington, DC: American Psychological Association/National Institute of Occupational Safety and Health. In press.Google Scholar
  46. 46.
    Murphy LR, DuBois D, Harrell JJ: Accident reduction through stress management.Journal of Business Psychology 1986; 1:5–18.CrossRefGoogle Scholar
  47. 47.
    Flannery RB, Jr.:Becoming Stress-Resistant Through the Project SMART Program. New York: Continuum, 1990, pp. 115–118.Google Scholar
  48. 48.
    Dawson J, Johnson M, Kehiayan N, et al.: Response to patient assaults: A peer support program for nurses.Journal of Psychosocial Nursing and Mental Health Services 1988; 26:8–15.PubMedGoogle Scholar
  49. 49.
    Flannery RB, Jr., Hanson MA, Sudders ML, et al.: An Ecological Model of Staff Victims of Patient Assault: Impact of Management Variables. Unpublished manuscript, Cambridge Hospital, Cambridge, MA, 1993.Google Scholar

Copyright information

© Association of Mental Health Administrators 1994

Authors and Affiliations

  • Raymond B. FlanneryJr.
    • 1
    • 3
  • M. Annette Hanson
    • 2
    • 3
  • Walter E. Penk
    • 2
    • 3
  1. 1.Department of PsychiatryThe Cambridge HospitalCambridge
  2. 2.Clinical and Professional Services, in the Massachusetts Department of Mental HealthUSA
  3. 3.faculty of Harvard Medical School in the Department of PsychiatryUSA

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