Assessment of aggression in psychiatric admissions: semistructured interview and case note survey
Psychiatrists fail to ask their patients about violent intentions to others, and may therefore be putting them and the public at risk, suggests research in this week's BMJ.
Milne and colleagues from St Luke's Hospital, Middlesbrough, carried out semistructured interviews with 114 people admitted to general psychiatry wards at the hospital over a period of three months. Patients were asked whether they had thought about suicide, damaging property, and violence towards another person in the preceding week. Comparisons were then made with the number of patients who had been asked about these thoughts by the treating team.
Almost half said that they had had suicidal thoughts and a quarter of the patients had entertained violent thoughts about specific people. Nearly one in 10 admitted owning a weapon and one in 20 to carrying one, both of which are recognised risk factors for violence. Over half of the patients had a history of violent behaviour. But although the clinical team almost always asked their patients about suicidal thoughts, only 2.5 per cent asked about damage to property and only 13 per cent asked about thoughts of violence towards others.
In an accompanying editorial, Shaw argues that politicians tend to assume that it is easier to predict violence by psychiatric patients than it actually is. Nevertheless, it is essential to ask patients about violent thoughts, because although not all of them will act on it, some will; and enquiring routinely about thoughts of violence to others is as important as enquiring about suicidal thoughts. But she points out that there is no legislation to help doctors in this regard and that they are faced with the dilemma of needing to maintain patient confidentiality while wanting to protect the public.
(Paper) Dr Steven Milne, St Luke's Hospital, Middlesbrough
Tel: 01642 283350
Fax: 01642 283 345
Caroline Parnell, PR Manager, Tees and North East Yorkshire NHS Trust
Tel: 01642 854 956
(Editorial) Dr Jenny Shaw, Guild Community Health Care NHS Trust, Preston, Lancashire
Tel: 01772 406 614
Fax: 01772 406 629