Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

Abstract

Background: There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care.

Aims: To assess whether such risk assessments decrease the incidence of violence and coercion.

Method: A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients.

Results: Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease.

Conclusions: Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.