Patients prone to violence

By MARTIN JOHNSTON health reporter

Fifteen per cent of patients admitted to an acute psychiatric unit committed violent acts or were verbally aggressive, a study has found.

The study involved 535 patients admitted to a Waikato District Health Board unit over a nine-month period.

Violent acts against staff made up a quarter of the 124 aggressive incidents by 80 patients, and those against patients nearly a tenth.

Two of the victims needed immediate medical attention.

The findings will be presented to the Australian and New Zealand College of Psychiatrists conference in Hamilton tomorrow.

The researchers say violence in acute psychiatric units is frequent and increasing.

"There is a need for suitable resources and staff training to effectively identify, minimise and manage serious threats or actual violence," they say in a preview.

More than half the patients involved in the aggressive incidents had a history of violence, and 68 per cent had a history of substance abuse.

Union delegates who work at acute units in the Auckland region have attributed growing patient violence to a shortage of staff - and of beds, which they say leads to patients having to be suffering worse symptoms to be admitted.

But one of the Waikato researchers, psychiatrist Dr Selim El-Badri, said that explanation for increased violence was too simple.

"One of the reasons may be because we use risk and dangerousness as one of the criteria [for admission]."

The legislative definition of mentally disordered - in order to have someone compulsorily assessed and treated - includes the patient posing a serious risk of harming him- or herself or others.

Dr El-Badri said at least two-thirds of the violent incidents in the study occurred within a fortnight of admission.

This was because patients' symptoms were generally at their worst around that time.

Other researchers will tell the conference that the rate of homicide by the mentally ill has remained static over the past 30 years - just over five a year based on the current population of 4 million.

But looking at all killings, which have increased steeply in that period, the proportion committed by the mentally ill has declined - from around 20 per cent in 1970 to 6 per cent in 2000.

Studies in violence

Researchers say violence in acute psychiatric units is on the rise.

68 per cent of patients involved in aggressive incidents had history of substance abuse.

But other research shows proportion of homicides committed by the mentally ill has declined.