Security procedures in a psychiatric emergency service

Abstract

The issue of violence in the mental health setting has recently begun to gain attention in the literature. As there is not enough research on this issue to draw conclusions as to the frequency of violence in mental health settings, there is a need to gather empirical data on the frequency of violence in various settings and to investigate the causes and management of this phenomenon. This article seeks to assess the prevalence of violence and potential violence in an inner-city psychiatric emergency service using several parameters as indicators. In addition, the article seeks to outline skills necessary for the management of violent patients which includes the recognition of potentially violent behavior, a hierarchy of management techniques to prevent the occurrence of violence, and techniques specifically designed to stop violence without causing patient or staff harm. Various etiologies of violence in mental health settings are discussed and a cognitive hierarchy of aggression is presented. Legal and ethical issues surrounding the concept of forcing patients to accept treatment on the basis of their dangerousness are discussed. Finally, the question of a difference in the prevalence of violence between ethnically different patient populations is raised, along with the possible implications of such a difference. Recommendations are made for the management of the potentially violent or violent patient.