Psychiatric Quarterly

, Volume 77, Issue 3, pp 239–249

Characteristics of Assaultive Psychiatric Patients: Fifteen-Year Analysis of the Assaulted Staff Action Program (ASAP)

  • Raymond B. FlanneryJr.
  • Jerry Juliano
  • Susan Cronin
  • Andrew P. Walker
Original Paper

Abstract

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.

Keywords

Assaulted staff action program (ASAP) Assaults Characteristics Patients 

References

  1. 1.
    Peek-Asa C, Schaffer K, Kraus J, et al.: Surveillance of nonfatal workplace assault injuries using police and employers reports. Journal of Occupational and Environmental Medicine 40:707–713, 1998.PubMedCrossRefGoogle Scholar
  2. 2.
    Soloff PH, Gutheil TG, Wexler DB: Seclusion and restraint in 1985: A review and update. Hospital and Community Psychiatry 36:652–657, 1985.PubMedGoogle Scholar
  3. 3.
    Blair DT: Assaultive behavior: Does provocation begin in the front office? Journal of Psychosocial Nursing 29:21–26, 1991.Google Scholar
  4. 4.
    Davis S: Violence in psychiatric patients: A review. Hospital and Community Psychiatry 42:585–590, 1991.PubMedGoogle Scholar
  5. 5.
    Lipscomb JA, Love CC: Violence toward health care workers: An emerging occupational hazard. American Association of Hospital Nurses Journal 40:219–227, 1992.Google Scholar
  6. 6.
    American Psychiatric Association. Clinician Safety. Task Force Report #33. Washington, DC, American Psychiatric Press, 1992.Google Scholar
  7. 7.
    Flannery RB Jr, Hanson MA, Penk WE: Risk factors for psychiatric inpatient assaults on staff. Journal of Mental Health Administration 21:24–31, 1994.PubMedCrossRefGoogle Scholar
  8. 8.
    Hansen W: Workplace violence in the hospital psychiatric setting: An occupational health perspective. American Association of Hospital Nurses Journal 44:575–580, 1996.Google Scholar
  9. 9.
    Occupational Safety and Health Administration: Guidelines for Preventing Workplace Violence in Health Care and Social Service Workers. Publication #3148. Washington, DC, United States Department of Health and Human Services, 1996.Google Scholar
  10. 10.
    Busch AB, Shore MF: Seclusion and restraint: A review of the literature. Harvard Review of Psychiatry 8:261–270, 2000.PubMedCrossRefGoogle Scholar
  11. 11.
    Flannery RB Jr: Assaultive patients in community residences: Review of findings and implications for health care safety. Journal of Health Care Safety, Compliance, and Infection Control 4:218–220, 2000.Google Scholar
  12. 12.
    Flannery RB Jr: Characteristics of assaultive psychiatric inpatients: Updated review of findings, 1995–2000. American Journal of Alzheimer's Disease and Other Dementias 16:153–156, 2001.PubMedCrossRefGoogle Scholar
  13. 13.
    Flannery RB Jr: Psychiatric patient assault and staff victim gender: Review of findings. Journal of Healthcare Safety, Compliance, and Infection Control 5:69–72, 2001.Google Scholar
  14. 14.
    Flannery RB Jr: Repetitively assaultive psychiatric patients: Review of published findings, 1978–2001. Psychiatric Quarterly 73:229–237, 2002.PubMedCrossRefGoogle Scholar
  15. 15.
    Flannery RB Jr: Precipitants to psychiatric patient assaults on staff: Review of empirical findings, 1990–2003. Psychiatric Quarterly 2004, in press.Google Scholar
  16. 16.
    Medical Directors Council, National Association of State Mental Health Program Directors: Reducing the use of seclusion and restraint: Findings, strategies, and recommendations. Emergency Psychiatry 6:7–13, 2000.Google Scholar
  17. 17.
    Flannery RB Jr: The Assaulted Staff Action Program: Coping with the Psychological Aftermath of Violence. Ellicott City, MD, Chevron Publishing Corporation, 1998.Google Scholar
  18. 18.
    Litz B (Ed): Early Interventions for Trauma and Traumatic Loss. New York: Guilford Press, 2004.Google Scholar
  19. 19.
    Flannery RB Jr, Schuler AP, Farley EM et al.: Characteristics of assaultive psychiatric patients: Ten Year analysis of the Assaulted Staff Action Program (ASAP). Psychiatric Quarterly 73:59–69, 2002.Google Scholar
  20. 20.
    Lion JR, Snyder W, Merrill GC: Underreporting of assaults on staff in a state hospital. Hospital and Community Psychiatry 32:497–498, 1981.PubMedGoogle Scholar
  21. 21.
    Devilly GJ, Cotton P: Psychological debriefing and the workplace: Defining a concept, controversies and guidelines for intervention. Australian Psychologist 38:144–150, 2003.CrossRefGoogle Scholar
  22. 22.
    Everly GS Jr, Mitchell JT: Critical Incident Stress Management (CISM): A New Era and Standard of Care in Crisis Intervention. 2nd Ed. Ellicott City, MD: Chevron Publishing, 1999.Google Scholar
  23. 23.
    Seligman MEP: The effectives of psychotherapy: The Consumer Reports study. American Psychologist 50:965–974, 1995.PubMedCrossRefGoogle Scholar
  24. 24.
    McNally RJ, Bryant RA, Ehlers A: Does early psychological intervention promote recovery from posttraumatic stress disorder? Psychological Science in the Public Interest 4:45–79, 2003.CrossRefGoogle Scholar
  25. 25.
    Flannery RB Jr, Juliano J, Walker AP: Past violence, substance use disorder and subsequent violence toward others: Six year analysis of the Assaulted Staff Action Program (ASAP). International Journal of Emergency Mental Health 21:143–148, 2000.Google Scholar
  26. 26.
    Campbell A, Muncer S, Bibel D: Female-female criminal assault: An evolutionary perspective. Journal of Research in Crime and Delinquency 35:413–429, 1998.CrossRefGoogle Scholar
  27. 27.
    Flannery RB Jr: Violence in America: Coping with Drugs, Distressed Families, Inadequate Schooling, and Acts of Hate. New York, NY, Continuum Publishing, 2000.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Raymond B. FlanneryJr.
    • 1
  • Jerry Juliano
    • 2
  • Susan Cronin
    • 2
  • Andrew P. Walker
    • 2
  1. 1.Department of PsychologyWorcester State HospitalWorcesterUSA
  2. 2.Massachusetts Department of Mental HealthBostonUSA

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