Violence in mental health settings: A systematic review

Abstract

The introduction of smoke‐free policies is increasingly common in mental health settings, to improve health. However, a barrier to implementing smoke‐free polices is staff concern that violence will increase. We conducted a systematic review comparing the rates of violence before and after the introduction of smoke‐free policies in mental health settings. Two authors searched major electronic databases. We included studies reporting the prevalence of violence (verbal and/or physical or combined) before and after the introduction of a smoke‐free policy in a mental health, forensic, or addiction setting. We included 11 studies in the review. A narrative synthesis was used to describe the key results of each study. Six studies measured physical violence specifically; four reported a decrease or no change and two reported a short‐term increase. Five of these six studies also measured verbal violence; two found an increase, with one of the studies reporting that this increase was temporary. Three reported a decrease in verbal violence. A further five studies evaluated the rate of combined verbal and physical violence; four reported a decrease or no change and the other an increase. We conclude that the introduction of smoke‐free policies generally does not lead to an increase in violence. There is a need for more robust studies to support this finding. However, the conclusions from this review may be a step in reducing staff concerns.

Smoking‐related violence in a mental health setting following the implementation of a comprehensive smoke‐free policy: A content analysis of incident reports

“…However, as previously stated, two researchers coded the data independently and quality checks were carried out. We found fewer incidents of smoking-related violence during the comprehensive policy period than the indooronly policy period, but cannot infer causality because we have not adjusted for the inpatient clinical population during these two periods (Robson et al 2017;Spaducci et al 2018). Whilst this study identified the frequency of the antecedents of smoking-related violence including staff response to breaches of smokefree policy and staff denying a patient request to smoke, we could not include the number of incidents occurring within such categories that did not lead to violence.…”

“…; Spaducci et al . ). Whilst this study identified the frequency of the antecedents of smoking‐related violence including staff response to breaches of smoke‐free policy and staff denying a patient request to smoke, we could not include the number of incidents occurring within such categories that did not lead to violence.…”

“…However, nine out of 10 studies included in a systematic review by Lawn and Pols (2005) evaluating changes in violence following implementation of smokefree policies found either no change or a decrease in violence. A more recent systematic review reported that eight out of 11 studies found either no change or a reduction in verbal or physical violence post-policy implementation (Spaducci et al 2018). We previously evaluated the effect of introducing a comprehensive smoke-free policy on physical violence across four UK NHS psychiatric hospitals using a time series design, accounting for confounding variables that may have influenced rates of violence such as patient demographics and clinical characteristics (Robson et al 2017).…”

Barriers and facilitators of clinician and researcher collaborations: a qualitative study

“…At the time of the study the authors worked in the 'Psychosis Theme' which aimed to help people who experience psychosis improve their physical health, by increasing access and uptake of evidence-based interventions to improve outcomes related to sedentary behaviours [19,20] and tobacco smoking [21,22]. Also integral to this work, we explored staff and organisational barriers to implementing tobacco dependence treatment interventions in mental health settings [21][22][23][24]. In preparation for future implementation work, we wanted to understand the barriers and facilitators to engaging in and with research, from the perspectives of clinicians and researchers.…”

Protocol of a scoping review assessing injury rates and their determinants among healthcare workers in western countries

“…Recently, the WHO, the ‘International Labour Organization’, the ‘International Council of Nurses’ and the ‘Public Services International’ jointly drafted a document entitled ‘Framework guidelines for addressing workplace violence in the health sector’ 28. The risk of physical violence is particularly high among HCWs working in psychiatric wards 29. Indeed, according to a recent review of the literature, lifetime rates of overall assaults, physical and verbal threats and sexual harassment in acute psychiatric units are 24%–80%, 46%–78.6%, 43%–78.6% and 9.5%–37.2%, respectively.…”