Abstract
The issue of violence in the mental health setting has recently begun to gain attention in the literature. As there is not enough research on this issue to draw conclusions as to the frequency of violence in mental health settings, there is a need to gather empirical data on the frequency of violence in various settings and to investigate the causes and management of this phenomenon. This article seeks to assess the prevalence of violence and potential violence in an inner-city psychiatric emergency service using several parameters as indicators. In addition, the article seeks to outline skills necessary for the management of violent patients which includes the recognition of potentially violent behavior, a hierarchy of management techniques to prevent the occurrence of violence, and techniques specifically designed to stop violence without causing patient or staff harm. Various etiologies of violence in mental health settings are discussed and a cognitive hierarchy of aggression is presented. Legal and ethical issues surrounding the concept of forcing patients to accept treatment on the basis of their dangerousness are discussed. Finally, the question of a difference in the prevalence of violence between ethnically different patient populations is raised, along with the possible implications of such a difference. Recommendations are made for the management of the potentially violent or violent patient.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bell C. C. Interface between psychiatry and the law on the issue of murder. J Natl Med Assoc. 1980 Nov;72(11):1093–1097. [PMC free article] [PubMed] [Google Scholar]
- Bell C. C. States of consciousness. J Natl Med Assoc. 1980 Apr;72(4):331–334. [PMC free article] [PubMed] [Google Scholar]
- Bell C. C. The role of psychiatric emergency services in aiding community alternatives to hospitalization in an inner-city population. J Natl Med Assoc. 1978 Dec;70(12):931–935. [PMC free article] [PubMed] [Google Scholar]
- Cornfield R. B., Fielding S. D. Impact of the threatening patient on ward communications. Am J Psychiatry. 1980 May;137(5):616–619. doi: 10.1176/ajp.137.5.616. [DOI] [PubMed] [Google Scholar]
- Griffith Elwin J., Griffith Ezra E. Duty to third parties, dangerousness, and the right to refuse treatment: problematic concepts for psychiatrist and lawyer. Calif West Law Rev. 1978;14(2):241–274. [PubMed] [Google Scholar]
- Gutheil T. G. Restraint versus treatment: seclusion as discussed in the Boston State Hospital case. Am J Psychiatry. 1980 Jun;137(6):718–719. doi: 10.1176/ajp.137.6.718. [DOI] [PubMed] [Google Scholar]
- Guze S. B., Woodruff R. A., Jr, Clayton P. J. Psychiatric disorders and criminality. JAMA. 1974 Feb 11;227(6):641–642. [PubMed] [Google Scholar]
- Holinger P. C. Violent deaths among the young: recent trends in suicide, homicide, and accidents. Am J Psychiatry. 1979 Sep;136(9):1144–1147. doi: 10.1176/ajp.136.9.1144. [DOI] [PubMed] [Google Scholar]
- Lazare A., Cohen F., Jacobson A. M., Williams M. W., Mignone R. J., Zisook S. The walk-in patient as a 'customer': a key dimension in evaluation and treatment. Am J Orthopsychiatry. 1972 Oct;42(5):872–883. doi: 10.1111/j.1939-0025.1972.tb00774.x. [DOI] [PubMed] [Google Scholar]
- Levy P., Hartocollis P. Nursing aides and patient violence. Am J Psychiatry. 1976 Apr;133(4):429–435. doi: 10.1176/ajp.133.4.429. [DOI] [PubMed] [Google Scholar]
- Lion J. R., Madden D. J., Christopher R. L. A violence clinic: three years' experience. Am J Psychiatry. 1976 Apr;133(4):432–435. doi: 10.1176/ajp.133.4.432. [DOI] [PubMed] [Google Scholar]
- Madden D. J., Lion J. R., Penna M. W. Assaults on psychiatrists by patients. Am J Psychiatry. 1976 Apr;133(4):422–425. doi: 10.1176/ajp.133.4.422. [DOI] [PubMed] [Google Scholar]
- Marcovitz E. Aggression in human adaptation. Psychoanal Q. 1973;42(2):226–233. [PubMed] [Google Scholar]
- Whitman R. M., Armao B. B., Dent O. B. Assault on the therapist. Am J Psychiatry. 1976 Apr;133(4):426–429. doi: 10.1176/ajp.133.4.426. [DOI] [PubMed] [Google Scholar]