Psychiatric Quarterly, Vol. 76, No. 4, Winter 2005 (
PRECIPITANTS TO PSYCHIATRIC
PATIENT ASSAULTS ON STAFF:
REVIEW OF EMPIRICAL FINDINGS,
1990–2003, AND RISK MANAGEMENT
Raymond B. Flannery, Jr., Ph.D.
Psychiatric patient assaults on staff are a serious and continuing problem in
health care settings. Over thirty years of empirical research have documented
the characteristics of both patient assailants and staff victims. Notably absent
from this literature have been similar empirical studies on the nature of patient
precipitants to these assaults. This paper reviewed empirical studies of patient
assault precipitants from 1990–2003. Six studies from three countries were
reviewed. Common precipitants included staff restrictions on patient behaviors,
denial of services, excessive sensory overload, and provocation by others. The
clinical, methodological, and risk management implications are examined.
KEY WORDS: assault precipitants; psychiatric patient assailants; risk management
strategies; staff victims.
Raymond B. Flannery, Jr., Ph.D., is afﬁliated with Massachusetts Department of Men-
tal Health and Harvard Medical School.
Address correspondence to Raymond B. Flannery, Jr., Ph.D., Department of Psychology/
6B, Worcester State Hospital, 305 Belmont Street, Worcester, MA 01604.
2005 Springer Science+Business Media, Inc.