Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

Br J Psychiatry. 2008 Jul;193(1):44-50. doi: 10.1192/bjp.bp.107.045534.


Background: There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care.

Aims: To assess whether such risk assessments decrease the incidence of violence and coercion.

Method: A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients.

Results: Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease.

Conclusions: Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aggression
  • Coercion*
  • Delivery of Health Care / standards*
  • Female
  • Hospitals, Psychiatric
  • Humans
  • Inpatients / psychology*
  • Male
  • Mental Disorders / nursing*
  • Mental Disorders / psychology
  • Middle Aged
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Violence / prevention & control*
  • Violence / statistics & numerical data