Responding to inpatient violence at a psychiatric hospital of special security: a pilot project.

Within secure psychiatric hospitals, staff have to manage many difficult and challenging situations. Crichton (1997) suggested that when staff perceive a greater degree of responsibility on patients for their actions there is a particularly morally censorious response. The aim of this pilot study was to discover if this association, discovered using a hypothetical scenario, was also present in how nursing staff respond to real violent patient behaviour. Over a five week period all episodes of inter-personal violence in a hospital with special security were identified and those involved interviewed. Thirty-one episodes of inter-personal violence were identified. A disproportionate number were caused by female patients and patients detained under civil sections of mental health legislation. A personality disorder diagnosis and the staff belief that mental disorder did not reduce the individual patient's blame for the incident were associated with the response of a restrictive sanction (both cases p < 0.01).