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Violence in Clinical Psychiatry Held in Stockholm from the 21St Till the 24Th Clinical of October 2009

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Violence in Clinical Psychiatry Held in Stockholm from the 21St Till the 24Th Clinical of October 2009 Nico Oud Henk Nijman Palmstierna Tom Patrick Callaghan Ian Needham Ian Needham - Patrick Callaghan - Tom Palmstierna - Henk Nijman - Nico Oud Ian Needham - Patrick Callaghan - Tom Palmstierna - Henk Nijman - Nico Oud VIOLENCE “Assessing, treating and caring Proceedings of the 6th European Congress on for potentially violent patients” VIOLENCE IN “Assessing, treating and caring for potentially violent patients” is the motto of the 6th European Congress on Violence in Clinical Psychiatry held in Stockholm from the 21st till the 24th CLINICAL of October 2009. IN This book of conference proceedings offers an overview of C the work of many clinicians, researchers, and others on topics LINICAL PSYCHIA PSYCHIATRY pertinent to the field of clinical violence such as legal and ethical perspectives on violence, the impact of violence on patients and staff, coercive measures, the pharmacological treatment of violence, the biology of violence, and interventions to address the problem of violence in clinical psychiatry. The congress offers a platform to all persons interested in the subject and to encourage the congress participants to engage in discussion and exchange on the various facets of violence. Readers of the conference proceedings will benefit from the topical findings presented here and will receive a wealth of stimulating ideas to enrich their own clinical practice. TRY Ian Needham Patrick Callaghan Tom Palmstierna Henk Nijman Nico Oud Violence in Clinical Psychiatry Design and production: DM Creatieve Communicatie. The Netherlands. www.dmhaarlem.nl Dr. Ian Needham Prof. Dr. Patrick Callaghan Prof. Dr. Tom Palmstierna Prof. Dr. Henk Nijman Mr. Nico Oud Editors Violence in Clinical Psychiatry Proceedings of the 6th European Congress on Violence in Clinical Psychiatry 21 – 24 October 2009 City Conference Centre Folkets Hus – Stockholm Sweden 4 ©2009 Kavanah, Dwingeloo & Oud Consultancy, Amsterdam Publisher KAVANAH Eemster 2 7991 PP Dwingeloo The Netherlands [email protected] www.kavanah.nl Oud Consultancy & Conference Management Hakfort 621 1102 LA Amsterdam The Netherlands Telephone: +31 20 409 0368 Telefax: +31 20 409 0550 [email protected] www.oudconsultancy.nl ISBN-10: 90-5740-069-3 ISBN-13: 978-90-5740-069-8 All Rights Reserved. No part of this publication may be produced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, without the permission in writing of the copyright owner (Oud Consultancy & KAVANAH) and the concerned author. 5 Preface Fifteen years ago the very first conference on Violence in Clinical Psychiatry was held in Stockholm. This year we return to Stockholm and offer once again a platform for practitioners, researchers, users, and policy makers to exchange, debate and discuss strategies to address violence in clinical settings. The return to Stockholm offers us the opportunity to report our impressions on some of the developments in clinical psychiatry we have observed in the last 15 years. It has come to our notice that practitioners, researchers, and policy makers are endeavouring to understand the views of patients who employ violence and who are also on the receiving end of institutional measures used to counteract violence. The appraisal of such institutional reactions may – depending on one’s own standpoint – be located anywhere on a continuum ranging from the legitimate use of executive power to handle violent behaviour to malicious counter violence. In earlier years the focus was on the management of violent patients based on the assumption that violent behaviour was an objective entity inherent in the perpetrator alone. More recently, some have advocated that violence is attributable to or at least provoked by professionals. The current state of knowledge would suggest that both positions taken concurrently may offer a better explanation of the cause of violence. Attempts to understand violent behaviours are not only to be found in ethical papers on violence in clinical psychiatry but in the form of a reflexive approach by staff which is apparent in many of the conference presentations. We can also report that some large-scale national efforts have been initiated to reduce the use of coercive measures, such as seclusion, in Europe. As mentioned above the use of coercive measures per se is viewed by many to be a form of institutional violence against patients and thus all efforts to reduce these will be welcomed by patients and professionals alike. Our observations suggest that there seems to be a rise in cross-cultural comparisons of practices surrounding coercive measures in the various countries represented by the papers in this conference. Discussions involving professionals from different countries reveal that many cultural differences exist in their views of various kinds of coercive measures. In some countries belts for mechanical restraint are deemed barbarous, but the use of psychotropic substances is seen as more humane. Professionals in some countries abhor the use of seclusion and would condemn 6 this as solitary confinement. In at least one case the value attached to coercive practices is expressed in the linguistic term: The Dutch word for a belt or strap to mechanically restrain a patient is termed the “zweedse band” (the Swedish strap). These observations underscore the necessity to be sensitive to the cultural context of violence and aggression. The use of aggression assessment and prediction tools also seems more uniform and standardised across Europe. More and more countries are using translations of the same tools, such as the BVC, the HCR-20, and the SOAS-R which renders comparisons between institutions, regions, and countries possible. This trend toward standardisation is to be welcomed providing that these instruments are used carefully, are open to development and are a means of predicting and registering violence and not an end in themselves. Another important observation is the augmentation of studies aiming to investigate the effectiveness of interventions aiming at reducing aggression or coercive measures at ward level. Some of this research includes randomised controlled trials or other well-controlled designs. Studies like these show that ward teams and ward managers understand the necessity of including adequate control conditions in attempting to learn which interventions work in reducing aggression. This development indicates that the scientific community is gradually transcending the stage of descriptive or epidemiological research – although such studies remain important – and striving to find the best empirical evidence for specific interventions. This – rather sketchy and impressionistic – tour d’horizont of the last 15 years shows that much progress has been made. We must, however, confess that there is still a lot of work ahead before we can contend that we have the adequate knowledge and capabilities for assessing, treating and caring for potentially violent patients. Therefore it would seem that we have ample goals and motivation for the 7th European Congress on Violence in Clinical Psychiatry to be held in Prague, Czech Republic, from the 20th till the 22nd of October 2011., However, for the meantime we hope you enjoy and profit from the current conference in Stockholm. Ian Needham Patrick Callaghan Tom Palmstierna Henk Nijman Nico Oud 7 The Scientific Committee Ass. Prof. Tom Palmstierna (Sweden) (chair) Prof. Henk Nijman (Netherlands) (chair) Dr. Ian Needham (Switzerland) (co-chair) Prof. Thomas Kallert (Germany) Prof. Seamus Cowman (Ireland) Dr. Mary E. Johnson (USA) Prof. Tilman Steinert (Germany) Dr. Richard Whittington (UK) Prof. Patrick Callaghan (UK) Prof. Stål Bjørkly (Norway) Prof. Dirk Richter (Germany) Dr. Anu Putkonen (Finland) Dr. Brodie Paterson (UK) Prof. Thanos Douzenis (Greece) Dr. Mojca Dernovsek (Slovenia) Dr. Hulya Bilgin (Turkey) Dr. Roger Almvik (Norway) Dr. Joy Duxbury (UK) Dr. Denis Ryan (Ireland) Ass. Prof. Lars Kjellin (Sweden) Prof. Sabine Hahn (Switzerland) Mr. Kevin McKenna (Ireland) The Organisation Committee Henk Nijman Tom Palmstierna Richard Whittington Thomas Kallert Ian Needham Nico Oud 8 Content Chapter 1 – Keynote speeches . 27 Chapter 2 – Auto-aggressive and Suicidal Behaviour . 38 Chapter 3 – Consumer and Staff Perspectives on Violence . 40 Chapter 4 – Legal and Ethical Perspectives on Violence.............53 Chapter 5 – The Impact and Effect of Violence on Patients . 60 Chapter 6 – The Impact and Effect of Violence on Staff .............72 Chapter 7 – The Nature and Epidemiology of Violence .............98 Chapter 8 – The Pharmacological Treatment and Biological Determinants of Violence..........................117 Chapter 9 – The Psychological Treatment of Violence . .132 Chapter 10 – Reducing Coercive Measures.......................164 Chapter 11 – Risk Assessment, and Prediction of Violence . 214 Chapter 12 – Sexual Violence .................................282 Chapter 13 – Specific Organizational Interventions related to Violence .....................................292 Chapter 14 – Specific Populations and Violence: Forensic Psychiatry......................................302 Chapter 15 – Specific Populations and Violence: General Health Care . 329 Chapter 16 – Specific Populations and Violence: Children, Youth and Adolescents.................................340 Chapter 17 – Staff Training and Violence ........................353 Announcement . 384 9 Preface ..........................................................5
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