Dirk Richter

Post-traumatic stress disorder following patient assaults among staff members of mental health hospitals: a prospective longitudinal study

BackgroundViolence by patients against staff members in mental health institutions has become an important challenge. Violent attacks may not only cause bodily injuries but can also have posttraumatic consequences with high rates of stress for mental health staff. This study prospectively assessed posttraumatic stress disorder (PTSD) in employees who were severely assaulted by patients in nine German state mental health institutions.MethodsDuring the study period of six months 46 assaulted staff members were reported. Each staff member was interviewed three times after the violent incident, using the Impact of Event Scale-Revised (IES-R), a widely used PTSD research tool, as well as the Posttraumatic Stress Disorder Checklist – Civilian (PCL-C).ResultsIn the baseline assessment following an assault by a patient, eight subjects (17%) met the criteria for PTSD. After two and six months, three and four subjects respectively still met diagnosis criteria.ConclusionA small minority of assaulted employees suffer from PTSD for several months after a patient assault.

Interactional aspects of violent behaviour on acute psychiatric wards

Abstract Violence on psychiatric wards involving staff and patients is a significant problem in many countries. Whilst patient psychopathology is often a factor, the violent interaction between ward staff and patients is often comparable to other violent interactions in the outside world. Thus, approaches from the social sciences can help to analyse the interactional patterns on psychiatric wards in order to benefit from their similarity to “ordinary” violent interactions. The concepts of aversive stimulation and double contingency are applied here to conclude that many acts of violence on wards occur following frustration or other rule imposition by staff. Both staff and patients can be seen as coping with perceived threat presented by the other in the interaction in a context of uncertainty about the behaviour of the other. The combination of misunderstanding, reciprocal anger and need for safety underpins an escalating tension in the interaction. These notions help us to understand these interactions better and could be incorporated in training for mental health staff.

The Effects of Aggression Management Training for Mental Health Care and Disability Care Staff: A Systematic Review

BACKGROUND Aggression management trainings for staff have been implemented in many organizations of mental health care and disability care. The efficacy of such programmes has rarely been analysed. METHODS A systematic review was conducted which contains all published evaluation studies on aggression management trainings. Inclusion criteria were before-and-after-comparisons or control group designs. RESULTS 39 published studies were included. Study quality has to be regarded as low. Concerning the results of the studies, no clear trend emerged in direction of minimising violent incidents. However, studies revealed clear positive effects on knowledge about violence and on staffs confidence to cope with difficult situations. CONCLUSIONS Sensitisation effects in staff after getting trained probably lead to reporting bias. Although the results on the number of violent incidents remain unclear, it is recommended to conduct comprehensive aggression management trainings in mental health and disability care institutions.

De-escalation in mental health care: a review of non-physical conflict management techniques

Until present, conflict management in mental health care relies much on physical techniques. Not surprisingly, research literature on interpersonal de-escalation in medical sciences, social sciences and psychology is rare. This presentation reviews rules and techniques that are applicable to mental health care [1]. Based on empirical data and theoretical models on the emergence of violence in psychiatry, following issues are discussed in detail: stress and anger management of staff, basic de-escalation rules, body language, facial expressions, verbal interventions. It is concluded that de-escalation in mental health care is still in its beginnings.