Determinants and Characteristics of the Violent Incidents in a Tertiary-Level Mental Health Care Center

Background The Mental Health Care Act of India, 2017 has for the first time focused on violence management interventions, especially restraint and seclusion in psychiatric settings, and recommended important guidelines in this aspect. Objective This situation has created a strong need to review the prevalence of violence in inpatient settings, associated clinical and social correlates keeping a preventive model in context. Hence, this study was undertaken to fulfill this need. Methods: A retrospective matched case–control chart review design was employed. All patients who exhibited at least one violent incident during their ward stay were included. For each case, the control was selected by individual matching based on age ± 2 years and gender from patients who were admitted during the study period but did not exhibit any violent incident. The information about the characteristics of violent incidents and management was also collected. Results 8.80% of patients exhibited at least one incident of violence and a total of 186 violent incidents were recorded during the study period. Variables including involuntary admission, history of the previous admission, history of violence, impulsivity, lack of insight, and irritability at the time of admission significantly predicted the likelihood of violent incidents. The use of chemical restraining was the most common method of management of violent incidents. Conclusion Violent incidents in psychiatric inpatient settings are still common. Efforts should be made to understand the risk as well as antecedent factors well in time. Verbal de-escalation should be employed and chemical and physical restraint should be used only as a last resort after exhausting the least restrictive interventions.