Forensic psychiatric inpatients and aggression: An exploration of incidence, prevalence, severity, and interventions by gender

Recorded incidents in a high‐secure hospital: A descriptive analysis

“…Gender differences in aggression are not always found in forensic psychiatric populations (Nicholls et al, 2009), but it is clear that female forensic patients in general have a high level of clinical need (Logan and Blackburn, 2009;Nicholls et al, 2009). There is evidence of higher levels of co-morbidity in women than in men.…”

Coercion in Forensic Healthcare: A North American Perspective

“…A large-scale retrospective audit in Quebec revealed that 40.7 % of 2721 patients admitted to an adult psychiatric hospital experienced seclusion with or without restraint, and 77.2 % of seclusions were accompanied by mechanical restraints (Dumais et al 2011). A 1-year retrospective file review in a sample of 527 forensic inpatients indicated that violence risk was managed with PRN in 40.8 % of male aggressors and in 22.2 % of female aggressors (Nicholls et al 2009). Seclusion with and without restraint was used to manage male patients in 77.8 % of the cases and 63.3 % of female aggressive incidents.…”

“…A retrospective file review on aggressive incidents in a forensic psychiatric hospital in British Columbia indicates that seclusion with or without restraint and the use of PRN were the primary interventions (63.3-77.8 %) used to manage serious incidents of physical violence, and/or inappropriate sexual behaviours (Nicholls et al 2009). Further examination of the sample revealed that a small subset (10 %) of the population (N ¼ 527) was responsible for 60 % of all perpetrated aggression (Lussier et al 2010).…”

“…Furthermore, they had more prior hospitalisation and were more likely to present with brain damage or cognitive impairment. Lussier et al (2010) and Nicholls et al (2009) did not primarily focus on seclusion and restraint; however, as such, their evidence speaks more to the profile of chronic perpetrators of inpatient aggression. Similarly, the SR interventions in Heilbrun et al (1995) were targeted toward 20 % of the entire forensic population, and for this subgroup psychopathy correlated significantly with SR incidence.…”

The Short Anger Measure

“…Given that nurses are more frequently the target of aggression and assault than other health professionals and patients (Daffern & Howells 2002;Cornaggia, Beghi, Pavone, & Barale 2011;Gudjonsson, Rabe-Hesketh, & Wilson, 2000;Nicholls, Brink, Greaves, Lussier, & Verdun-Jones, 2009), the ability to assess risk and formulate appropriate interventions may be considered a core nursing skill (Norman & Parrish 1999). Although anger need not be a contributing factor in all acts of aggression (Howells, 2004), its association with violence provides a strong rationale for its assessment (Doyle & Dolan, 2006).…”