Reducing Inpatient Aggression: Does Paying Attention
Karen A. Nolan Æ Leslie Citrome
Published online: 20 October 2007
Ó Springer Science+Business Media, LLC 2007
Inpatient aggression is poorly documented in ofﬁcial records. Video tech-
nology can improve detection, but is labor-intensive and costly. We examined the
effectiveness of interventions to improve reporting on a secure inpatient research unit
equipped with audio/video surveillance.
Systematic review of all video recorded during a six-week period in 2000
revealed that ofﬁcial documentation omitted 16/71 aggressive incidents (23%). Subsequent
interventions to improve reporting involved therapy aides, whose jobs entail continuous
direct contact with patients. We reviewed the corresponding period in 2005 to investigate
changes in aggression and reporting.
Although the number of aggressive incidents did not change signiﬁcantly,
reporting improved: 59/62 (95%) events detected in 2005 had been reported. Physical
aggression decreased and verbal aggression increased.
Improved reporting may have the unanticipated beneﬁt of reducing phys-
ical aggression, perhaps by fostering recognition of and intervention in events that might
otherwise escalate into more serious aggression.
Keywords Aggression Á Schizophrenia Á Schizoaffective disorder
Although the relationship between mental illness and violence remains controversial,
aggression in inpatient psychiatric settings is accepted to be a serious problem. Only a small
proportion of inpatients are physically aggressive but the disruptive effects of aggressive
K. A. Nolan (&) Á L. Citrome
Nathan S Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg,
NY 10962, USA
K. A. Nolan Á L. Citrome
Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA
Psychiatr Q (2008) 79:91–95