Exploring the Utility of the Model for Understanding Inpatient Aggression for General Mental Health Settings

Abstract

A comprehensive understanding of factors contributing to aggression within mental health inpatient units is necessary to generate timely preventative interventions. In practice however, the focus is dominated by consideration of factors that are intrinsic to patients. The Model for Understanding Inpatient Aggression (“the model”) was developed for use in a forensic mental health service to understand and help prevent aggression by exploring distal and proximal intrinsic patient-level ‘personal’ factors and extrinsic ‘contextual’ factors'- structural, organisational and interpersonal. The model also incorporates exploration of ‘near miss events’ when aggression does not occur, to learn about aggression and support early use of effective intervention strategies. This study explored whether the model is suitable for use in civil/general mental health inpatient settings. Fifteen people (n = 14 nurses, and n = 1 lived and living experience expert) participated in one of four focus groups. Data were analysed using thematic analysis. Three themes were constructed from the data: (1) Focus remains on intrinsic factors and post event exploration and not early intervention and prevention; (2) “Turning the mirror” on ourselves: The importance of considering and addressing contextual factors; and (3) ‘For us it might fill a gap’: Benefits of using the Model for Understanding Inpatient Aggression. Participants also suggested additions to the model so that it aligns with practice in general mental health inpatient units. In conclusion, understanding and preventing aggression remains a constant challenge. Intervention efforts may be broadened when a wide range of contributing factors is considered, beyond proximal intrinsic/personal patient characteristics.