A Systematic Perspective of Violence and Aggression in Mental Health Care: Toward a More Comprehensive Understanding and Conceptualization

  • John R. CutcliffeEmail author
  • Sanaz Riahi
Part of the Principles of Specialty Nursing book series (PSN)


The significant majority of models and conceptualizations of violence and aggression in mental health reflect or capture only some of the multitude of influencing variables and invariably disproportionately assign the responsibility for such behaviors to clients. More comprehensive views consider more variables and depict the issue as more complex and multi-directional. As a result this chapter explores a wide range of phenomena that have been found to have an association with aggression and violence (A/V) in inpatient mental health care. These propositions are synthesized according to fit or congruence into a systemic model of A/V, and the authors examine the empirical evidence pertaining to these propositions, and then the chapter begins to consider application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The systemic model is comprised of four thematic categories: environmental-related phenomena, client-related (intrapersonal) phenomena, mental health-care system-related phenomena, and clinician-related phenomena. The chapter then discusses a number of implications arising out of embracing a more systemic model of A/V in mental health care. In broadening our understanding to include all the phenomena that contribute increased risk of A/V incidents, we are able to move away from inaccurate views that disproportionately assign ‘responsibility’ to clients for causing A/V when the evidence indicates that the client-related phenomena may only account for a small portion of these incidents.



This chapter has been adapted and reproduced, with kind permission from the publisher, from the journal articles referenced: Cutcliffe JR, Riahi S (2013) A systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization – part one. Int J Ment Health Nurs 22(6):558–567 and Cutcliffe JR, Riahi S (2013) A systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization – part two. Int J Ment Health Nurs 22(6):568–578


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© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Cutcliffe ConsultingKingstonCanada
  2. 2.School of NursingCoimbraPortugal
  3. 3.Director, Professional PracticeClinical Information and Adolescent Services, Ontario Shores Mental HealthOntarioCanada

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