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The National Audit of Violence: in-patient care for adults of working age

  • Robert Chaplin (a1), Maureen McGeorge (a2) and Paul Lelliott (a2)
Abstract
Aims and Method

We audited 184 psychiatric wards against clinical practice guidelines for the management of violence. Staff and service users completed anonymous questionnaires. Environmental inspections were performed by two teams.

Results

There were 4460 questionnaires returned. Nurses (78%) were significantly more likely to report the experience of violence than service users (37%). Drugs were reported by 72% of nurses and alcohol by 61% as causing problems. Other standards frequently not met included staffing levels, training, provision of activities, ward design and ambience.

Clinical Implications

Specific issues are identified that must be addressed by national and local action. A baseline is set against which the impact of this action can be judged. Priorities must include tackling drug and alcohol use in psychiatric wards.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Department of Health (2000) Managing Violence in Mental Health and Managing Violence in the Community. London: Department of Health.
Department of Health (2002) Mental Health Policy Implementation Guide: Adult Inpatient Care Provision. London: Department of Health.
Department of Health (2004) The National Service Framework for Mental Health – Five Years On. London: Department of Health.
Healthcare Commission (2005) The National Audit of Violence (2003–2005). Final Report. http://www.healthcarecommission.org.uk/_db/_documents/04017451.pdf
Lelliott, P. (2004) The National Patient Safety Agency. Psychiatric Bulletin, 28, 193195.
Marshall, H., Lelliott, P. & Hill, K. (2004) Safer Wards for Acute Psychiatry. London: National Patient Safety Agency. http://www.npsa.nhs.uk/site/media/documents/1241_SWAP_ResearchReport.pdf
McGeorge, M., Lelliott, P. & Stewart, J. (2001) Managing violence in psychiatric wards: preliminary findings of a multi-centres audit. Mental Health Care, 31, 366369.
National Institute for Clinical Excellence (2005) Violence: The Short Term Management of Disturbed / Violent Behaviour in Inpatient Psychiatric Settings and Emergency Departments. London: NICE. http://www.nice.org.uk/page.aspx?o=cg025fullguideline
Pieters, G., Speybrouck, E., De Gucht, V., et al (2005) Assaults by patients on psychiatric trainees: frequency and training issues. Psychiatric Bulletin, 29, 168170.
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Royal College of Psychiatrists (1998) The Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services (Occasional Paper OP41). London: Royal College of Psychiatrists.
Wildgoose, J., Briscoe, M. & Lloyd, K. (2003) Psychological and emotional problems in staff following assaults by patients. Psychiatric Bulletin, 27, 295297.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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The National Audit of Violence: in-patient care for adults of working age

  • Robert Chaplin (a1), Maureen McGeorge (a2) and Paul Lelliott (a2)
Submit a response

eLetters

Post-incident debriefing following Physical Violence between patients and staff

Ravi S Sohal, Specialist Registrar
08 January 2007

The National Audit of Violence highlighted many important issues which can reduce the risk of violence in in-patient settings (Chaplin et al., 2006). In 2004-5, 43 000 physical assaults occurred in mental healthtrusts. The adverse effects on the mental health of staff and effective interventions to manage these sequelae tend to be neglected in research.

Although debriefing remains controversial, the National Institute forClinical Excellence (NICE) recommended a post-incident review take place within 72 hours of an incident (NICE, 2005). In an audit on post-incidentdebriefing reviews following physical violence, I administered a questionnaire by telephone to the ward managers of all adult in-patient units at the Central & North-West London mental health trust.

All 4 psychiatric intensive care units (PICUs) and 18 out of 19 adultpsychiatric wards participated in the audit. All PICUs and 14 (82%) of adult psychiatric wards stated that they would arrange reviews within 72 hours of an incident of physical violence, and the remainder within 1 week. However, over a 6 month period in 2006, only half of PICUs and one-third of general adult wards consistently arranged post-incident reviews following each incident of physical violence which was reported by incident forms.

The audit highlighted a need for training ward managers to lead post-incident reviews and significant practical difficulties in organising reviews, due to problems such as availability of staff and lack of time, that face many acute psychiatric wards (Lelliot et al, 2006). Organisational changes will reduce the risk of violence but incidents willcontinue to occur and provisions should also be put in place to support staff and patients.

Chaplin, R., McGeorge, M. & Lelliot, P. (2006) The National Audit of Violence: in-patient care for adults of working age. PsychiatricBulletin. 30, 444-446.

Healthcare Commission. (2005). The National Audit of Violence (2003-2005). Final report http://www.healthcarecommission.org.uk/_db/_documents/04017451.pdf

Lelliot, P., Bennett, H., McGeorge, M & Turner, T. (2006) Accreditation of acute in-patient mental health services. Psychiatric Bulletin. 30, 361-363.

Author: Dr Ravi Sohal, Specialist Registrar in General Adult Psychiatry, Mental Health Centre, Northwick Park Hospital, Watford Road, Harrow, Middx. HA1 3UJTel No: 020 8869 2305Fax No: 020 8869 2291

Declaration of Interest: None
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Conflict of interest: None Declared

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