Review and Proposed Management of Violence in the Secure Psychiatric Ward

Anger, hostility, aggression and violence are commonly encountered in the secure psychiatric wards. These acts interfere with the therapeutic milieu and cause unrest amongst both staff and patients. Understanding the aetiology and variables associated with these are critical to establishing safer wards. In this review article we amalgamate and summarize findings from research within the last ten years. We use evidence from recent research, clinical guidelines and our individual experiences to describe how simple interventions may help in reducing the incidence in locked wards. which lead to violence by patients who are admitted to the wards, regardless of their psychiatric diagnosis. We will discuss briefly how this can be prevented with particular emphasis on the beneficial effects of changing the ward structure, organization and design. To aid our review a literature search was conducted on articles produced in the last ten years around the aetiology of anger/hostility and violence. Our search yielded three sets of guidelines from NICE which included short term management, and the prevalence of violence/aggressive behaviors in those with a mental health diagnosis. We found two systematic reviews which focused on aggression in psychiatric wards and three research articles investigating the aetiology.