The interpersonal dynamics of aggression and violence in mental health inpatient units

Rationale: Mental Health professionals' ability to manage aggression and violence in mental health units is hampered by a lack of evidence-based research. Aim: The research aimed to investigate the relationship between Health Professional attitudes and subsequent aggression by mental health inpatients. Method: An interpersonal model specific to inpatient mental health units guided three empirical studies. Study one investigated patient views on staff management of aggression. Study two examined specific staff variables such as rigid attitudes in dealing with aggression. Study three investigated the impact of a management philosophy upon staff attitudes in a controlled design. Results: In study one, patients reported that interpersonal factors with mental health staff were salient contributors to their aggression. Study two extended this and found that high staff rigidity was associated with low tolerance for patient aggression. Interestingly, staff characterised by low rigid attitudes were found to be more involved in high severity aggressive incidents. Study three found training in zero tolerance had the unintended consequence of increasing rigid attitudes, while reducing tolerance toward aggression. Discussion: Staff play a role in helping or hindering inpatients with aggressive impulses. Staff with less rigid attitudes were those most likely to assist in difficult incidents, those incidents that are likely to be unavoidable. More rigid staff were involved in a greater proportion of low-medium severity incidents, those incidents likely to be more easily avoided if managed well. Management approaches that reduced tolerance toward aggression appeared to have a negative impact on variables most likely to help patients manage aggressive impulses. Together these studies highlight that staff and management policy are critical variables in understanding and responding to aggression.