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Published Online: 1 May 2012

Longitudinal Trends in Using Physical Interventions to Manage Aggression and Self-Harm in Mental Health Services

Richard Whittington, Ph.D. [email protected], Maria Leitner, Ph.D., Wally Barr, Ph.D. [email protected], Gillian Lancaster, Ph.D., and James McGuire, Ph.D. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 63, Number 5
https://doi.org/10.1176/appi.ps.201000274
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Abstract

Objectives:

Repetitive aggression by a patient receiving mental health inpatient care is likely to elicit various patterns of response from care staff over time. This study sought to examine patterns of coercive physical intervention in relation to repeated episodes of aggression by particular patients.

Methods:

A data set of 9,945 aggression and self-harm incidents over a five-year period in one mental health service in England was constructed. Incidents by a specific individual were categorized according to their position in a sequence (first, second, and so on) and by the use of physical intervention by staff to manage the incident.

Results:

Trends in the use of physical intervention varied across settings. There was a significant tendency in general (nonforensic) services for use of physical intervention to increase in response to physical aggression (physical intervention in first versus subsequent incidents: odds ratio [OR]=.69, 95% confidence interval [CI]=.54–.90) and to decrease in response to threats (physical intervention in first threat versus subsequent threats: OR=1.62, CI=1.09–2.39).

Conclusion:

There were significant trends over time in the use of physical intervention to manage violence and self-harm. However, the dynamics behind this finding will remain unclear without further research. (Psychiatric Services 63:488–492, 2012; doi: 10.1176/appi.ps.201000274)

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Figures and Tables

Table 1 Characteristics of 4,909 inpatients involved in aggression or self-harm at one urban mental health service in England, 1999–2004
Table 2 Likelihood of using physical intervention in the first incident of aggression or self-harm and the first three incidents in a series compared with all subsequent incidents

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 63 • Number 5 • May 2012
Pages: 488 - 492
PubMed: 22388474

History

Published online: 1 May 2012
Published in print: May 2012

Authors

Details

Richard Whittington, Ph.D. [email protected]
Dr. Whittington, Dr. Barr, and Dr. McGuire are affiliated with the Institute of Psychology, Health and Society, University of Liverpool, Thompson Yates Building, The Quadrangle, Liverpool L69 3GB, United Kingdom (e-mail: [email protected]).
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Maria Leitner, Ph.D.
Dr. Leitner is with InfoTech UK Research, Cheshire, United Kingdom.
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Wally Barr, Ph.D. [email protected]
Dr. Whittington, Dr. Barr, and Dr. McGuire are affiliated with the Institute of Psychology, Health and Society, University of Liverpool, Thompson Yates Building, The Quadrangle, Liverpool L69 3GB, United Kingdom (e-mail: [email protected]).
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Gillian Lancaster, Ph.D.
Dr. Lancaster is with the Postgraduate Statistics Center, University of Lancaster, Lancaster, United Kingdom.
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James McGuire, Ph.D. [email protected]
Dr. Whittington, Dr. Barr, and Dr. McGuire are affiliated with the Institute of Psychology, Health and Society, University of Liverpool, Thompson Yates Building, The Quadrangle, Liverpool L69 3GB, United Kingdom (e-mail: [email protected]).
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