[THE LEVEL OF VIOLENCE IN CLOSED PSYCHIATRIC WARDS IN RELATION TO THE LEGAL STATUS OF THE INPATIENTS.].

BACKGROUND

One of the most serious problems in closed psychiatric wards is the issue of violence. Many studies have tried to characterize the violent patients hospitalized in a closed ward. Some research has shown that the strongest predictor of violence is past violence. The closed wards in the country consist of civil patients and patients hospitalized according to a court order following a history of violence, side by side. In this article, we characterized cases of violence that took place in closed wards in 2015, and in addition we examined the effect of hospitalization status on patient aggression and the level of violence in the wards.

METHODS

The study was performed retrospectively using data from hospital medical and nursing records and reports of unusual events from a risk management database. The subjects included in the study are men and women between the ages of 18-65 years who were admitted to a closed ward in 2015 with a reported violent incident for which they were responsible. The data were examined for the specific event and the percentage of those admitted due to a court order out of all the participants in the violent events was noted. Furthermore, the authors examined the number of violent events with respect to the percentage of those hospitalized by court order in the department at that time. In addition, we examined each violent case and characterized it by pre-determined variables.

RESULTS

As to the legal status, it was clearly found that those hospitalized with a court order were more involved in assault cases. However, it was not found that a higher percentage of those hospitalized by a court order raised the level of violence in the department. In terms of their characterization, the cases of assault were more frequently performed by men, by young people and by bachelors. The clinical diagnoses that characterized the attackers were prolonged disorders of the psychotic spectrum. Most of the events involved physical assault of other patients and staff. The event usually took place in the early days of the hospitalization, most often in the ward lobby and during morning hours.

CONCLUSIONS

According to the research hypothesis, patients under a court order are found to be responsible for more cases of violence in active wards. At the same time, the high attendance of those hospitalized by a court order does not increase the amount of violence in the department. These results support the idea of separating outpatients in court orders from other patients, in order to reduce violence in active psychiatric wards, improve inpatient conditions, and adjust dedicated care for populations of different legal status.