Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

ABSTRACT

Objective: The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence; and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables; using two-way tables and Chi-Square or Fisher's Exact Tests. Results: The prevalence of violence among the long-term patients was 16. Fighting among patients was the most common form of violence (58). The most significant risk factors of violence among the long-term patients are A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay 12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. Conclusion: The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a disproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms; but more in their cognitive ability; coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement