[Managing aggression in a forensic psychiatric unit for adolescents: literature review and clinical implementation]

Abstract

Background: Aggressive incidents are part and parcel of everyday life in a forensic psychiatric unit for adolescents.

Aim: To review the literature about the prevalence of aggressive incidents and about aggression management policy in (forensic) child and adolescent psychiatry and to explain and elaborate the aggression management protocol in a newly established unit.

Method: The literature was reviewed systematically using PubMed and PsycINFO in order to locate studies in English and Dutch published since 1990.

Results: Only 10 publications reported prevalence data on aggressive incidents in child or adolescent psychiatric units. Literature about concrete policy guidelines was almost non-existent. 27% to 78% of the youngsters had been involved in some kind of aggression. The lack of clear definitions and the differences in the research designs made a reliable comparison impossible.

Conclusion: To date, there is no evidence that a greater number of aggressive incidents occur in a forensic psychiatric unit for adolescents than in a regular adolescent psychiatric unit. Further research into both the prevalence and the characteristics of incidents is required in order to provide cues for a good policy. This policy will need to include structural and relational security measures that are firmly supported by the systematic registration of incidents and by continuous risk assessment.