Gary J. Maier

A Report on Staff Injuries and Ambulatory Restraints: Dealing With Patient Aggression

1. During a 6 1/2-year period on a unit designed for repetitively aggressive male patients, nursing staff members were the recipients of 95% of aggressions and 97% of serious injuries. 2. Two-point ambulatory restraints, called Preventive Aggression Devices (PADS) help liberate the patient from prolonged seclusion, but in a safe manner. 3. Patient aggression is underreported; there is a need for a standardized aggression reporting system across facilities.

Relationship security: the dynamics of keepers and kept.

Hiring, training and supervising treatment staff who work closely with forensic patients at all levels of security requires careful planning. In particular, staff must identify and share feelings like fear and anger that are always generated when patients threaten or attack staff. Approaches to dealing with staff countertransference to patients are suggested in this article, and aids to breaking the aggression cycle are discussed. Relationship security is a working through of dynamics that are always in operation where there are keepers and kept.

Litigiousness as a Resistance to Therapy

With the criminalization of the mentally ill, increasing numbers of patients with experience in the criminal justice system are entering psychiatric facilities, and “jailhouse lawyers” are becoming more familiar to clinicians. While the use of grievances and lawsuits as methods of asserting control and harassing staffs is well known, there has been less discussion of patients’ litigiousness serving as resistance to dealing with other issues in therapy. The authors discuss this subject, and present methods for minimizing the problems, including dealing with the reinforcement of such resistance by adversarial advocates.

The Munchausen patient in a forensic facility

The many reports in the literature of chronic factitious illness (Munchausens Syndrome) have emphasized the difficulty of treating these patients because of their propensity to leave medical facilities as soon as the factitious nature of their symptoms is discovered, and because of their disinclination to accept psychiatric help. The authors report on their treatment of such a patient who was incarcerated for over ten years under a criminal commitment, and discuss methods for overcoming resistances to treatment in Munchausens patients.

THE AGGRESSIVE PATIENT/INMATE: BEYOND DENIAL

The public is no longer willing to tolerate being repeatedly victimized by a small group of sexually and/or physically aggressive predators. These predators may be found among much larger groups of non-predatory inpatients in psychiatric hospitals or inmates in prisons. These institutionalized people deserve to be treated or incarcerated without fear of being victimized, as well. The U.S. Supreme Court has recently recognized the principle of protecting the public from such predation, in its Kansas v Hendricks decision. This paper details the philosophy, management, unit construction, legislative changes, and intervention strategies necessary to contain such predators and to propel them toward rehabilitation-once we have given up our denial about the existence of such people.

Hospice-assisted deaths in a forensic facility: A comparison of patient reactions

With the adventof AIDS a significant number of inmates are now dyingon medicalunitsin prisons.1On suchunits all theinmatesshareacommon plight and for that reasonthe general therapeuticmilieu can be managedto meetthespecific medical, psychological andspiritualneedsof the inmates.2As aconsequence thestaffin securityfacilities havehad to become moreawareof theprocessof dying.In particular,staff at someprisonshave becomemoreawareofthestagesof the dying processdescribedby KublerRoss in her famousbook “On Death and Dying” andthe valueof hospice principlesin helpinginmatesdie.3

Psychopathy: Antisocial, Criminal, and Violent Behavior

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