Abstract
Background
The disturbed behaviour of acute in-patients can have serious consequences, and methods of management are contentious and vary between countries. Little is known about this variation and its relationship to the characteristics of in-patient populations.
Aim
The aim of this study was to compare rates and patterns of disturbed behaviours and containment methods in acute psychiatric wards in three centres in the United Kingdom, Italy and Greece.
Method
A retrospective survey of medical and nursing records (n=838) at seven hospitals for the first 2 weeks of patients' admissions was done using a structured data collection tool.
Results
Nearly all types of disruptive behaviour varied by centre, with rates being generally higher in the UK and lowest in Italy. Specific relationships between different behaviours were replicated across all three centres. Ethnic minority patients were more likely to be subject to containment measures in all centres, even when their behaviours did not differ from the majority. Rates of containment method use were only partially related to the frequency of disturbed behaviour.
Conclusions
More research is required to discover the efficacy of varying containment methods, with a view to minimising their use. Gross international and inter-hospital variation demands large samples rather than single site studies. Clinicians need to reflect upon containment rates that may be, in some places, excessive and incorrectly targeted.
Similar content being viewed by others
References
Bowers L, Alexander J, Callaghan P, Eales S, Guy S, McCann E, Ryan C (2002) Safety and security policies on psychiatric acute admission wards: results from a London-wide survey. J Psychiatr Ment Health Nurs 9:427–433
Bowers L, Simpson A, Alexander J (2003) Patient–staff conflict: results of a survey on acute psychiatric wards. Soc Psychiatry Psychiatr Epidemiol 38:402–408
Burns T, Firitti A, Holloway F, Malm U, Rossler W (2001) Case management and assertive community treatment in Europe. Psychiatr Serv 52(5):631–636
Clark N, Kiyimba F, Bowers L, Jarrett M, McFarlane L (1999) Absconding: nurses views and reactions. J Psychiatr Ment Health Nurs 6(3):219–224
Grassi L, Peron L, Marangoni C, Zanchi P, Vanni A (2001) Characteristics of violent behaviours in acute psychiatric in-patients: a 5-year Italian study. Acta Psychiatr Scand 104:273–279
Gudjonsson GH, Rabe-Hesketh S, Szmukler G (2004) Management of psychiatric in-patient violence: patient ethnicity and the use of medication, restraint and seclusion. Br J Psychiatry 184:258–262
Gunnell D, Frankel S (1994) Prevention of suicide: aspirations and evidence. Br Med J 308:1227–1233
Flannigan CB, Glover GR, Wing JK, Lewis SW, Bebbington PE, Feeney ST (1994) Inner London collaborative audit of admission in two health districts III: reasons for acute admission to psychiatric wards. Br J Psychiatry 165:750–759
Haller RM, Deluty RH (1988) Assaults on staff by psychiatric in-patients: a critical review. Br J Psychiatry 152:174–179
Hunter M, Carmel H (1989) Staff injuries from inpatient violence. Hosp Community Psychiatry 40(1):41–46
Kasper J, Hoge SK, Feucht-Haviar T, Cortina J, Cohen B (1997) Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure. Am J Psychiatry 154(4):483–489
Karasterigou A, Mastrogianni A, Georgiadou E, Kotrotsios S, Mauratziotou K (2005) The reform of the Greek mental health services. J Ment Health 14(2)197–203
Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Lovell A, Scheper-Hughes N (Eds) (1986) Psychiatry inside out: selected writings of Franco Basaglia. Columbia University Press, New York
Nijman H, Joost M, Campo A (2002) Situational determinants of inpatient self-harm. Suicide Life-Threat Behav 32(2):167–175
Nijman HLI, Palmstierna T, Almvik R, Stolker JJ (2004) Fifteen years of research with the staff observation aggression scale: a review. Acta Psychiatr Scand 1–10
Raja M, Azzoni A, Lubich L (1997) Aggressive and violent behavior in a population of psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 32:428–434
Sashidharan SP (2001) Institutional racism in British psychiatry. Psychiatri Bull 25:244–247
Shah AK, Fineberg NA, James DV (1991) Violence among psychiatric inpatients. Acta Psychiatr Scand 84:305–309
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bowers, L., Douzenis, A., Galeazzi, G.M. et al. Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres. Soc Psychiat Epidemiol 40, 822–828 (2005). https://doi.org/10.1007/s00127-005-0967-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-005-0967-1