Andrew P. Walker

Characteristics of Staff Victims of Pschiatric Patient Assaults: 15-Year Analysis of the Assaulted Staff Action Program (ASAP)

Psychiatric patient assaults on staff victims are a worldwide occupational hazard. This paper reports on a 15-year study of the characteristics of staff victims of patient assaults and a crisis intervention procedure to ameliorate the aftermath of theses incidents. The debate on the efficacy of early interventions is outlined and the present 15-year findings are presented, findings demonstrating remarkable consistency in victim characteristics over time. The crisis intervention procedures were associated with sharp declines in disrupted victim functioning. The validity of the study’s findings are noted and the implications for enhanced risk management training and staff victim crisis intervention procedures are discussed.

Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP)

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.

Characteristics of patient and staff victims of assaults in community residences by previously nonviolent psychiatric inpatients.

There currently exists a large body of empirical research examining patient assaults in inpatient psychiatric facilities. These studies have focused primarily on staff and have found younger, male mental health workers with lower levels of formal education and experience as well as nurses involved in restraint procedures to be most at risk. However, despite the increased utilization of community-based services, little attention has been directed toward patient assaults on patients and staff in community settings, particularly residential services. This study began to respond to this need by examining patient assaults toward other patients and staff in community residences during the first twelve months post-discharge for a group of newly discharged patients who were not violent as inpatients. This study found female patients and staff to be at greater risk for assault than male patients. Lack of experience by staff was also a risk factor. The clinical, administrative, and research implications of these findings are discussed.

Characteristics of staff victims of patient assault: ten year analysis of the Assaulted Staff Action Program (ASAP)

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.

Safety skills of mental health workers: empirical evidence of a risk management strategy

To reduce violence in the workplace, health care facilities invest time and resources in risk management strategies such as photo identification and controlled access and surveillance. Studies of assaultive psychiatric patients continue to document that mental health workers (MHWs) are the most frequent targets of the patient violence. Unexamined in these findings is the role skilled MHWs contribute in restoring safety and order in the aftermath of these assaults. This six-year, empirical retrospective study examined the safety skills of MHWs in containing violence. Although they were 28% of the workforce, MHWs restored order in the majority of single assault incidents and restraint procedures. Their skills appear to be a risk management strategy in their own right. The implications are discussed.

The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program.

Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.

Nonviolent psychiatric inpatients and subsequent assaults on community patients and staff

Health care staff on psychiatric inpatient units are at high risk for work-related assaults by patients. Recent studies have begun to document similar patient assaults toward staff in community-based residences. Earlier community studies did not control for the level of patient assault prior to community discharge, and it remains unknown whether the community residence assaults were a function of community placement or a reflection of ongoing control issues by the recently discharged patients. This preliminary inquiry retrospectively tracked the nature and frequency of assaults by patients newly discharged to community residences from a state hospital setting where there had been no assaults by these patients for a two-and-one half-year period. While base rates remain to be determined, the findings in this study suggest the assaultive patients to be younger males with diagnoses of schizophrenia and histories of violence toward others, substance abuse, and violence toward self. Nine patients committed the majority of the assaults. There was a significant decline in the frequency of assaults nine months post-discharge. The implications are discussed.

Psychiatric Patient Assault and Staff Victim Gender: Fifteen-year Analysis of the Assaulted Staff Action Program (ASAP)

Extensive, largely cross-sectional research has documented the continued occurrence of patient assaults on male and female staff. Different studies report either male or female staff to be at highest risk. Studies of same/different gender assaults which might more fully answer this question have been few. In these latter studies both male and female staff were at high risk for same gender assaults. In community settings males were at risk from same gender assaults but females were at risk from assaults by both patient genders. The present 15-year longitudinal retrospective study examined same/different gender assaults over time. Since the health care system under study experienced several major policy changes during these years, data were also examined at 5-year intervals to assess the stability of findings across time. Male and female staff were at increased risk from same gender assaults over time in both inpatient and community settings. The findings and their implications are discussed. In addition, a cost-effective, comprehensive risk management strategy for containing assaults is outlined.

Precipitants of elderly psychiatric patient assaults on staff: preliminary empirical inquiry.

Although there have been several studies of the characteristics of psychiatric patient assailants, there have been only six comprehensive, empirical assessments of precipitants to these assaults and no precipitant study has focused solely on elderly psychiatric patient assailants. This one and one-half year, retrospective study continued the inquiry into the nature of patient assault precipitants and focused only on elderly assailants. Older, male patients with a diagnosis of schizophrenia and histories of violence toward others and substance use disorder physically assaulted primarily male, mental health workers. These staff victims experienced disruptions in the domains of mastery, attachment, and meaning as well as the symptomatology associated with psychological trauma. The most common precipitants to these assaults were denial of services and acute psychosis. The findings and implications for health care providers in long-term care settings where elderly psychiatric patients reside are discussed.

Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP).

Literature reviews of individual assaultive patients, repetitively violent patients, and restrained assaultive patients document that persons diagnosed with schizophrenia or personality disorder are at the highest risk to become assaultive. While there has been some initial research of possible predictor variables across diagnostic groups, this six-year retrospective study is the first to compare only persons with schizophrenia or personality disorder on basic demographic and the selected clinical variables of history of violence, personal victimization, and substance use disorder. In this study, the variance suggested that persons with schizophrenia and personality disorder were both likely to be assaultive. Assaults by persons with schizophrenia were somewhat proportional to their presence in the population studied. However, personality disordered patients represented a disproportional increase from the population studied. Younger females with a diagnosis of personality disorder and with histories of violence toward others and personal victimization appeared at increased risk to be assaultive and to require restraints. The findings and their implications for safety and clinical care are discussed.