Violence in psychiatric wards. Role of the lax milieu.

In recent years there has been a marked increase in interest and publications dealing with violence in psychiatric facilities. There is general agreement that the increase in violent behavior is real despite underreporting prior to the late 1970s. The author proposes that the changes in structure and functioning of psychiatric facilities following the Community Mental Health Act of 1963 may be one of the factors responsible for the increase of violent behavior. To test this proposal, Index Medicus was searched for articles on violence in psychiatric facilities from 1935 through 1988. The first articles appeared in 1968. A review of leading textbooks of psychiatry during the same period revealed similar findings. The role of the lax milieu is discussed. It is proposed that the "medical model" as described in this paper be reinstituted in short-stay psychiatric facilities.