Reducing Aggressive Behaviour and Staff Injuries: A Multi-Strategy Approach

Article excerpt

Abstract

Objective: To evaluate the impact of a multi-strategy approach on the management of patient aggression and staff injury rates at a stand-alone mental health facility.

Methods: A multi-strategy aggression management program was developed and introduced over a 2-year period. The program had four components; staff education/training, a staff support program, risk assessment tools, and a computerised incident monitoring system. Aggressive incidents by patients, staff injuries due to patient aggression and compensation payments to staff for the 2-year period before implementation of the aggression management program were compared with the 3-year period following implementation of the program.

Results: There was a significant decrease in the number of staff injuries reported in the 3-year period following the implementation of the aggression management program. Although the number of aggressive incidents reported did decrease over the study period, the decrease was not statistically significant.

Conclusions: Despite the increasing acuity of the clients at the study facility, there was a significant decrease in staff injuries due to aggressive behaviour. The strategies implemented seem to offset the potential for violence. It is likely that the combined impact of the strategies is greater than the impact of individual strategies implemented consecutively.

Aust Health Rev 2006: 30(2): 203-210

A SIGNIFICANT COMPONENT of the mental health reform agenda in Australia involves the closure or downsizing of stand alone psychiatric hospitals and the decentralisation of services to regions of identified need. Large numbers of patients (and staff) have been relocated from psychiatric hospitals to enable beds and programs to be closed. Many patients with severe disability moved to supported living arrangements in the community or to smaller residential facilities designed to meet their ongoing rehabilitation and clinical needs. Psychiatric hospitals, although reduced in size, continue to provide extended rehabilitation and clinical services for a defined population. However, a negative consequence of hospital downsizing is the increase in aggressive behaviour in those clients who remain behind.1-3

It is clear that the downsizing of psychiatric hospitals and changes to mental health legislation have restricted access to inpatient care to the most difficult and disturbed patients in the system,4 with the resultant loss of higher functioning patients, who may act as buffers for the more disturbed patients. The effects of substance misuse and non-adherence to prescribed medications add to the risk of violence in this group.5 Aggressive behaviour continues to be a leading source of stress and personal injury for staff (and patients) in inpatient facilities.6-8 At the organisation level, aggressive behaviour can lead to lost productivity and increases in workers compensation costs, insurance costs, and refurbishment costs when repairs to the environment become necessary.9

The prevention of such violence involves a complex interaction between the client, their social structure and their environment. Nonetheless, a large literature on the management of aggressive behaviour identifies a number of possible aggression reduction strategies. The focus of most studies has been on training staff to more effectively manage aggressive behaviour.10,11 While the training of mental health staff has produced mixed outcomes,12 it does seem to improve job satisfaction13and confidence in the management of violent individuals.14

Providing support to victims of patient assault through a program of peer support has also been found to reduce the frequency of violence in mental health facilities.15,16 Peer support typically involves immediate and ongoing support for a staff member who has been traumatised as a result of assault.17 These peer support programs have been shown to aid return to work18 and decrease the symptoms associated with posttraumatic stress syndrome. …