Adam Gerace

The Role of Empathy in Anger Arousal in Violent Offenders and University Students

A lack of empathic responsiveness toward others has been consistently identified as an important antecedent to aggressive behavior and violent crime, with many rehabilitation programs for violent offenders incorporating treatment modules that are specifically designed to increase offender empathy. This study examined the extent to which cognitive (perspective taking) and affective (empathic concern, personal distress) empathy predicted anger in a clinical (male prisoners convicted of a violent offense) and a nonclinical (student) sample. Perspective taking emerged as the strongest predictor of self-reported anger in response to an interpersonal provocation, as well as being most consistently related to scores on measures of general trait anger and methods of anger control. While the relationship between perspective taking and anger was apparent for offenders as well as students, the results did not support the idea that an inability to perspective take is a particular characteristic of violent offenders.

The profile of absconding psychiatric inpatients in Australia

AIMS AND OBJECTIVES The purpose of this study was to examine absconding behaviour (a patient leaving the hospital without permission) in acute and rehabilitation wards of one Australian psychiatric institution to describe the characteristics of the absconding patient and these events. BACKGROUND Absconding is a significant issue in psychiatric inpatient settings, with risks that include patient harm, aggression and violence. In spite of this, limited research has been conducted in Australia on patients who abscond while receiving psychiatric care. DESIGN The study was a retrospective descriptive analysis. METHOD Absconding events from three acute and seven rehabilitation wards over a 12-month period were studied. RESULTS The rate of absconding events by detained patients was 20.82%. Gender was not significantly associated with absconding, although 61.19% of those who absconded were men diagnosed with schizophrenic disorders. Over half of acute care patients who absconded left during their first 21-day detention order. More than half of absconding events were by patients that absconded more than once. There was limited support for the efficacy of locking ward doors. Age and diagnosis emerged as particularly important factors to consider. DISCUSSION The study revealed that men are not more likely to abscond than women, that locking ward doors does not deter the determined absconders and that once a person has absconded, they are more likely to do so again. Younger patients and those with a schizophrenic disorder may be particularly likely to abscond. There also appears to be a link between continuing detention orders and an absconding event. CONCLUSIONS Findings provide new data about the profile of absconding patients in Australia. Exploration of the reasons why patients abscond and why many do so repeatedly warrants further investigation. RELEVANCE TO CLINICAL PRACTICE Risk management approaches taking into account factors associated with absconding could be trialled to reduce the incidence of absconding in psychiatric inpatient settings.

The development of CBT programmes for anger : the role of interventions to promote perspective-taking skills

Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.

Managing risk: clinical decision-making in mental health services.

Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patients health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

The use of restraint in four general hospital emergency departments in Australia

Objective: The purpose of this study was to investigate restraint use in Australian emergency departments (EDs). Method: A retrospective audit of restraint incidents in four EDs (from 1 January 2010 to 31 December 2011). Results: The restraint rate was 0.04% of total ED presentations. Males and females were involved in similar numbers of incidents. Over 90% of restrained patients had a mental illness diagnosis and were compulsorily hospitalised. Mechanical restraint with the use of soft shackles was the main method used. Restraint was enacted to prevent harm to self and/or others. Median incident duration was 2 hours 5 minutes. Conclusions: In order to better integrate the needs of mental health clients, consideration is needed as to what improvements to procedures and the ED environment can be made. EDs should particularly focus on reducing restraint duration and the use of hard shackles.

Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia.

Absconding is increasingly being recognized as a problem within mental health settings with significant risks for consumers. This study examines absconding behaviours across three acute care wards within an Australian psychiatric hospital campus over a 12-month period. A descriptive statistical analysis determined the rate of absconding from 49 consumers who absconded 64 times. The absconding rate was 13.33% (absconding events), with most absconding events arising from males diagnosed with schizophrenia (57.14%) aged between 20 and 29 years, and with 62.50% of absconding events occurring whilst consumers were on their first 21-day detention order. Nearly half of all absconding events were by consumers who had absconded previously, with the highest proportion of events occurring during nursing handover. A profile of people who abscond, time of day of absconding, legal status and repeated absconding behaviours are described. The emergent profile of consumers who absconded within this study bears some similarities to that described in overseas research, although in this study consumers were slightly older and 25% of absconders were female. Of particular interest are findings that identify the timings of absconding events in relation to a consumers legal status. Implications for practice, including assessment of risk of absconding and management, are considered.

Five-year review of absconding in three acute psychiatric inpatient wards in Australia

Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.

Multidisciplinary health professionals' assessments of risk: how are tools used to reach consensus about risk assessment and management?

Author accepted manuscript (Post-Print) made available in accordance with publisher copyright policy.

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

There are significant issues associated with the use of restrictive measures, such as seclusion and restraint, in child and adolescent mental health care. Greater understanding of how restrictive measures are used is important for informing strategies to reduce their use. In this brief report we present a 12-month audit (1/1/2010-31/12/2011) of the use of restrictive measures (seclusion, physical restraint) in one child and adolescent acute inpatient mental health unit in Australia. The study highlights the need for continued efforts to reduce the use of restrictive measures in child and adolescent mental health services.

The short anger measure: development of a measure to assess anger in forensic populations.

ABSTRACT In this brief report we describe the development of a measure of anger that may be used by nurses and other professionals to assess anger and changes in anger with male offenders. The Short Anger Measure, a 12-item self-report measure of angry feelings and aggressive impulses, was administered to 73 male offenders. The measure showed sound psychometric properties (internal consistency reliability, test–retest reliability) and concurrent validity with an established measure of anger. The potential use of the measure by nurses working in forensic settings is discussed.