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Aggressive behaviour in an acute general adult psychiatric unit

Adult Mental Health Service, Waikato Hospital, Pembroke Street, Hamilton, New Zealand, e-mail: elbadris{at}waikatodhb.govt.nz

Graham Mellsop, Professor of Psychiatry

Waikato Clinical School, University of Auckland

Declaration of interest

None.

AIMS AND METHOD

The study aimed to identify the correlates of aggressive behaviour in an adult acute psychiatric ward. Over a period of 9 months, all incidents of verbal and physical aggressive behaviour exhibited by in-patients were routinely assessed using the Overt Aggression Scale.

RESULTS

Of the 535 patients admitted during the study period, 80 (15%) were involved in a total of 124 aggressive incidents. Of these 80, 44 (55%) had a history of previous violence and 54 (68%) had a history of substance misuse. The majority of events occurred early in the hospital stay and in most cases aggression was against staff.There were significant differences between aggressive and non-aggressive patients in terms of gender and ethnicity, with the lowest rate occurring in European females.

CLINICAL IMPLICATIONS

These results reinforce clinical impressions, and empirical evidence, and allow risk assessment to be performed with greater confidence. The relevance of ethnicity (or more likely culture) highlights the difficulties of a ‘one size fits all’approach to risk assessment.