Academic journal article East Asian Archives of Psychiatry

Violence among Psychiatric Inpatients: A Victim's Perspective

Academic journal article East Asian Archives of Psychiatry

Violence among Psychiatric Inpatients: A Victim's Perspective

Article excerpt

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Introduction

In India, for more than 50 years, there was a practice of involving family members in the caretaking process for inpatients by asking them to stay with the patient during the period of hospitalisation. This practice is believed to enable faster recovery than patients admitted without accompanying family members. (1) By custom, families assume the role of principal caregivers for their ill relatives because of strong family relationships resulting in mutual interdependence and concern for relatives during adversity. An earlier study from India assessing the role of caregivers in patients with chronic schizophrenia found that in the majority of cases, family members were responsible for looking after their relative during inpatient stay and at home. (2) India has a huge population of subjects with psychiatric disorders and faces a severe shortage of mental health professionals. (3) Hence, a system of utilising the services of the family members has multiple advantages. These include assisting the limited staff available so as to facilitate a greater degree of personalised and better care for patients. (4) Thus, having adequate support from the family is of great benefit to the patient, the clinician, and health care administrators.

Violent patients in a psychiatric hospital pose a considerable challenge to psychiatric staff and health planners, because of the risks to the individuals involved and the implications for the organisation of services. These include longer hospitalisation, greater need for tranquilising medications, and more frequent medication changes, all of which have serious cost implications. Studies of inpatient violence are hard to compare because of differing definitions of violence and hospital settings in which the studies took place. A few western studies only focused on violence from the perspective of the staff and patients. It is important to recognise that the family members pay a huge price in the form of emotional, financial, psychological, and social burdens in the process of caring for relatives with psychiatric disorders, according to the western studies (5-8) and those from India. (9-11)

Although there have been studies looking at the caregiver burden on family members in a variety of domains, there have been none from the perspective of family members as victims of violence in a psychiatric setting where they stay with the patients during inpatient care. Hence, this study set out to examine this issue in an Indian setting.

Methods

The study was conducted in the adult psychiatric wards of National Institute of Mental Health and Neurosciences, a tertiary care psychiatric teaching hospital of Bangalore in southern India. The study was approved by the institutional ethics committee. A total of 100 consecutive incidents involving male and female inpatients exhibiting violent behaviour during the period April 2008 to July 2009 were included. Violence was defined as the use of physical force which intended to hurt or injure another person as per the National Institute of Clinical Excellence guidelines. (12) It includes physical violence (which required physical contact with victims) and non-physical violence (including threats of violence and fear-induced behaviour). Due to the difficulty reporting verbal aggression in crowded wards and the possibility of underreporting, it was excluded from the study unless concomitant threatening or physical aggression took place. The definition of violence used for the study also excluded violent incidents directed exclusively to oneself and to other objects. In other words, violent incidents committed only against other people were included. Sexual violence including inappropriate physical contact made by the patient against any other person was also not included as this was considered outside the purview of this study. Besides, repeated episodes of violence by the same patient were excluded. …

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