Psychiatric inpatient aggression A review of structural and functional assessment approaches

Despite the high rate of aggression on psychiatric wards, uncertainty exists about the nature of the relationship between mental illness, unpatient treatment and aggression. As a consequence, the frequently employed strategies used to manage aggressive inpatients, such as seclusion, isolation, sedation, and restraint, are implemented inconsistently and possibly selected on the basis of characteristics unrelated to the cause of aggression. Further, the implementation of these management strategies may precipitate aggression, model aggressive ways of interacting with others, or reinforce aggression. Aggression may, therefore, be maintained rather than eliminated through normal ward practices. The purpose of the present paper is to review the literature on psychiatric inpatient aggression. Assessment approaches in this area may be categorized as structural (which emphasise form) or functional (which emphasise purpose). Most research in this field has utilized a structural approach. While these studies have identified a number of demographic, clinical, and situational characteristics of high-risk individuals and environments, which assist resource allocation and actuarial assessments of risk, they fail to clarify the purpose of aggression or assist the development of psychological interventions aimed at reducing aggression. This review concludes that a functional analysis of inpatient aggression may guide the selection of management strategies used to contain aggressive incidents and ensure such strategies are consistent with the psychological interventions developed to reduce the likelihood of future aggression. The implications of this conclusion for future research are discussed.