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Accessible Summary What is known on the subject? Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self‐esteem and lead to feelings of shame. Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward. It is important to gain a sound understanding of violence in order to help reduce it. What the paper adds to existing knowledge? Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward. We identified several new factors associated with violent behaviour, such as engaging in self‐harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team. Implications for practice For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma‐informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma‐informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions. Abstract Introduction Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence. Aim We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self‐harm and being the target of violence. We also included seldom used service metrics. Method Data were extracted on admissions to acute adult wards and PICUs 2017–2020 within South London and Maudsley NHS Foundation Trust. A zero‐inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence. Results Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self‐harm, being the target of violence and referral to a Psychiatric Liaison Team. Discussion The novel associations found between enacting violence, self‐harm and being the target of violence indicate trauma‐informed care is crucial to reduce violent presentations of distress. Implications for practice System level interventions are crucial to ensure mental health nurses are supported to provide trauma‐informed care.
Instances of violence and aggression in acute psychiatric settings are common and highly distressing for service users and staff. They also incur financial costs. This study aimed to identify the proportion of service users at risk of consistent violence/aggression enactment. It also aimed to analyse associated service use to explore the potential need for specialised, targeted approaches. Five years’ worth of data were extracted from 2016 to 2020 on inpatient stays across South London and Maudsley NHS Foundation Trust (SLaM) acute adult wards and Psychiatric Intensive Care Units (PICUs). Service users were divided into cohorts based on relative number of violent/agressive incidents enacted. Differences in frequency of acute service use during the period 1st January-31st December 2020 were analysed. In total, 2524 service users had at least one inpatient stay during 2020. 679 were recorded as having enacted at least one incident of violence or aggression. Just 4% of all service users accounted for 50% of all violence/aggression enactment. Results further showed strong evidence of group differences between violence cohorts in the following domains: internal transfers, occupied bed days, admissions and Place of Safety (PoS) referrals. There was weaker evidence for group differences in referrals to Home Treatment teams (HTTs) and Psychiatric Liaison Teams. A small proportion of service users disproportionately account for the majority of violent and aggressive incidents and higher levels of violence and aggression are associated with more acute service use. The provision of targeted, personalised interventions for this cohort may reduce the enactment of violence and aggression, leading to improved quality life and a reduction in financial expenditure.
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