This study investigated the aggressive behaviour of all mentally ill patients within a whole psychiatric hospital with a catchment area of 325 000 inhabitants over a 1-year period (i) to assess the 1-year prevalence and characteristics of aggressive episodes and index inpatients, and (ii) to identify predictors of patients at risk by a multivariate approach. Staff Observation of Aggression Scale was used to assess aggressive behaviour. Characteristics of index inpatients were compared with those of non-index inpatients. Logistic regression analysis was applied to identify risk factors. A total of 171 out of 2210 admitted patients (7.7%) exhibited 441 aggressive incidents (1.7 incidents per bed per year). Logistic regression analyses revealed as major risk factors of aggression: diagnoses (organic brain syndromes OR = 3.6, schizophrenia OR = 2.9), poor psychosocial living conditions (OR = 2.2), and critical behaviour leading to involuntary admission (OR = 3.3). Predictors of aggressive behaviour can be useful to identify inpatients at risk. Nevertheless, additional situational determinants have to be recognized. Training for professionals should include preventive and de-escalating strategies to reduce the incidence of aggressive behaviour in psychiatric hospitals. The application of de-escalating interventions prior to admission might be effective in preventing aggressive behaviour during inpatient treatment especially for patients with severe mental disorders.

Since 1996 three psychiatric hospitals have been working together closely in a team aiming at improving the quality management of coercive measures. The first comparison of documented restraints showed conspicuous differences in incidence and duration. Due to this, the group decided to document and to compare the incidence, duration and reason of restraints and the legal status and sociodemographic variables in the three hospitals over one year. Considerable deviations were found with regard to the number and duration of restraints and number of patients concerned. Hospital A (2622 admissions) registered 103 restraints of 53 persons whereas hospital B (5802 admissions) reported 254 restraints of 121 persons, hospital C (4252 admissions) finally, documented 621 restraints of 120 persons. Hypotheses giving reason for these findings are discussed. Furthermore, developments and changes aiming at reducing coercive measures and at complete and comparative documentation by co-operation of the three hospitals, are reported.

OBJECTIVE Since 1996 three, meanwhile eight, psychiatric hospitals have been working closely together in a multidisciplinary team aiming at improving quality management and reducing the frequency and duration of coercive measures, respectively. METHODS Development, aims, and functioning of the cooperation are described, and selected data of comparisons of documented restraints and of coercive measures in one of the hospitals (1998-2004) are presented. RESULTS This way of cooperation was conductive to changes in organizational policies and practices of coercive measures and, in parts, resulted in reducing coercive measures. CONCLUSIONS The cooperation was effective in improving quality management and implementation of changes in practice of coercive measures.

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