Impacting on factors promoting intra-group aggression in secure psychiatric settings

Abstract

Three preliminary and linked studies investigate the impact of making alterations to factors considered relevant to engaging in and experiencing intra-group aggression (bullying) among adult male patients detained in a single secure forensic hospital. Study one (n = 44) outlines the institutional factors, attitudes towards bullying and environmental factors that increase the likelihood of engaging in bullying and/or being victimised. Study two (n = 53 patients and 167 staff) assesses the effect of three variations of intervention that aimed to reduce intra-group aggression through direct alteration of the physical and psychosocial environment, using data from both patients and staff. Study three (n = 414) looks at the effects of two variations of the intervention used in study two, which offered patients’ participation in individual and communal activities. It was predicted that changes to the physical and social environment would produce a reduction in the factors shown to predict intra-group aggression. Attitudes supportive of bullying and the presence of social hierarchies each increased the likelihood of engaging in bullying. Indirect changes to the social environment on the wards had more positive effects than those incorporating direct alterations to the physical and social environment. The differences in effectiveness of the two approaches are discussed in relation to the established predictors of intra-group aggression. The research concludes by noting the preliminary nature of the research and outlining potential directions for future research and intervention.

Patient safety in inpatient mental health settings: a systematic review

“…Ten studies114–123 examined challenging behaviour and techniques, such as de-escalation and communication strategies, which could be used to manage this; seven studies found techniques that were effective 114–120. A further four studies investigated conflict behaviour management techniques employed by staff124–126 and patients127; techniques used in the two intervention studies were effective in reducing conflict 126 127. Staff and patient attitudes towards critical incidents were the focus of four qualitative studies128–131; a further three studies focused on maintaining the psychological safety of patients who had experienced physical or sexual assault during an inpatient stay132 and outside of healthcare 133 134.…”

Towards an Integrative Theory of Bullying in Residential Care for Youth

“…Nevertheless, it demonstrated that such a method could be applied and that ensuring adherence to changes and quantifying this adherence was key. It was further evident from Ireland et al [39] that statistical power was an unavoidable issue, if applied within a single site. Consequently, any true testing of a model such as the MMB-RS should include as many residential care facilities in one country as possible.…”

“…However, this was a basic conceptual model that specified the pathways through which bullying could develop. The MMBSS progressed from this, taking advantage of increased research into prison bullying, and it has been applied to management and intervention [38] and underpinned evaluations [39]. According to the MMBSS, prison bullying is a product of an interaction between the prison environment and prisoners' personal characteristics (for the full MMBSS [15]; for a shorter review [7]).…”

“…Given the urgency to develop a theory of bullying in residential care, an experimental or quasi-experimental design seems more appropriate. Ireland et al [39] applied such a method (quasi-experimental) to test the MMBSS in a high secure forensic hospital, where direct alterations to the physical and social environment were made. This was only applied to one, albeit sizeable, hospital and required full clinical and management adoption, which is not always achievable for researchers.…”

Coercive bullying among forensic inpatients: How do individual and environmental factors contribute?

“…Jane Ireland is a leader in the academic investigation of bullying research in secure settings and has proposed a definition that deviates from those used in other settings. Contrary to Farrington's (1993) definition, Ireland proposes that bullying in secure settings 1) may be a single incident, rather than repeated behaviour, 2) does not require an imbalance of power between the perpetrating and victimized person, 3) does not require intention by the perpetrating person but the perception by the victimized person that they have been aggressed towards, and 4) can include direct, indirect, and coercive acts of aggression (Ireland, 2002a(Ireland, , 2004Ireland et al, 2019;Ireland & Bescoby, 2005). The full definition, applied across both correctional and forensic psychiatric settings, established by Ireland (2002a) is: "An individual is being bullied when they are the victim of direct and/or indirect aggression happening on a weekly basis, by the same perpetrator or different perpetrators.…”