Violent behaviour in a forensic psychiatric hospital in Finland: an analysis of violence incident reports

Abstract

The aim of this paper was to explore the frequency and provocation of physically violent incidents in a Finnish forensic psychiatric hospital. Three years (2007-2009) of violent incident reports were analysed retrospectively. The data were analysed by content analysis, and statistically by Poisson regression analysis. During the study period a total of 840 incidents of physical violence occurred. Six main categories were found to describe the provocation of violence where three of these categories seemed to be without a specified reason (61%), and three represented a reaction to something (36%). The risk for violent behaviour was highest for the civil patients (RR = 11.96; CI 95% 9.43-15.18; P < 0.001), compared to criminal patients (RR = 1). The civil patients represented 36.7% of the patients, and in 43.6% of the studied patient days, they caused 89.8% of the reported violence incidents. Patients undergoing a forensic mental examination did not frequently behave aggressively (RR = 1.97; CI 95% 0.91-4.28). These results can be used in the reorganization of health-care practices and the allocation of resources.

De‐escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital

“…In clinical practice, restrictive measures might partially prevent unwanted behaviours, but do not fully eliminate them, at least when used independently (Kuivalainen et al . ). This finding has also been reported with special observation (Stewart & Bowers ; Stewart et al .…”

Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses

“…Research in a forensic secure unit by Rutter, Gudjonsson and Rabe‐Hesketh () indicated that service users who had a greater tendency to engage in violence (>25 violent incidents over a period of 17 years) were more likely to be female, younger and to be on a civil section. A higher risk for females’ violent behaviour in forensic settings has been reported in several studies (Daffern, Mayer & Martin, ; Kuivalainen et al., ), with no specific explanations being offered. It has also been suggested that individuals who have been given a diagnosis of schizophrenia or personality disorder display greater levels of violence in secure hospitals than those without such diagnoses (Coid, Kahtan, Gault & Jarman, 1999; Rutter et al., ; Rylan, ) and that Caucasian service users are the aggressor in more incidents than non‐Caucasians (Dolan, Fullam, Logan & Davies, ).…”

“…In the United Kingdom (UK), almost half of the service users from a secure hospital were reported to have engaged in physical assaults over a 12‐month period (Novaco & Taylor, ), and a review from five secure USA services found that 31% of service users engaged in at least one violent assault over a year (Broderick, Azizian, Kornbluh & Warburton, ). In contrast, a study of a secure hospital in Finland revealed that only 17% of the service users had been violent over a 2‐year period (Kuivalainen, Vehvilainen‐Julkunen, Putkonen, Louheranta & Tiihonen, ). Violence in secure services results in longer periods of detention for service users, increases the risk of both harm to and burnout among staff, impairs treatment effectiveness, increases distress among service users and has important costs for the service in terms of staff members′ sick leave, compensation claims and employee turnover (Novaco & Taylor, ).…”

The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses’ Perspectives

“…The second group comprises patients with psychotic disorders for whom treatment is particularly difficult or dangerous or simply not feasible in a local community hospital. The third group comprises those undergoing a forensic mental examination (Kuivalainen, Vehviläinen‐Julkunen, Putkonen, Louheranta, & Tiihonen, ). In addition to these two state mental hospitals, forensic psychiatric patients are treated on seven forensic psychiatric wards located in different hospital districts (Tenkanen, Tiihonen, Repo‐Tiihonen, & Kinnunen, ).…”