Bart Thomas Roger Almvik Palmstierna Tom Henk Nijman Johan Håkon Bjørngaard Nico Oud Patrick Callaghan Patrick Callaghan - Nico Oud - Johan Håkon Bjørngaard Patrick Callaghan - Nico Oud - Johan Håkon Bjørngaard Henk Nijman - Tom Palmstierna - Roger Almvik - Bart Thomas Henk Nijman - Tom Palmstierna - Roger Almvik - Bart Thomas VIOLENCE “New horizons in interdisciplinary approaches” Proceedings of the 8th European Congress on The 8th European Congress on Violence in Clinical Psychiatry is taking place in the stimulating, idiosyncratic and authentic city of Ghent. VIOLENCE IN People from all corners of the world will deliver papers, symposia and workshops, present posters and debate how ‘new and interdisciplinary approaches’ might transform the landscape of violence research, CLINICAL education and practice. The concerns the congress addresses will be IN CLINICAL PSYCHIA of interest and signifi cance to people providing, using, developing and commissioning mental health and intellectual disability services, PSYCHIATRY as well as the people who shape policies. The congress showcases scientifi c advances in violence prevention, reduction, risk and management and their application to specifi c populations and topics. Leading international scholars who are at the forefront of thinking on violence in clinical psychiatry, and beyond, spearhead what promises to be a lively three days of making discoveries about violence in clinical psychiatry, and making these discoveries matter to people’s health and well being. Prof. Patrick Callaghan Mr. Nico Oud, MNSc ISBN 978-90-574-0112-1 Prof. Johan Håkon Bjørngaard Prof. Henk Nijman TRY Prof. Tom Palmstierna Dr. Roger Almvik 9 789057 401121 Mr. Bart Thomas, MSc Violence in Clinical Psychiatry Design and production: DM Creatieve Communicatie. The Netherlands. www.dmcreatief.nl Prof. Patrick Callaghan Mr. Nico Oud, MNSc Prof. Johan Håkon Bjørngaard Prof. Henk Nijman Prof. Tom Palmstierna Dr. Roger Almvik Mr. Bart Thomas, MSc Editors Violence in Clinical Psychiatry Proceedings of the 8th European Congress on Violence in Clinical Psychiatry 23 – 26 October 2013 Gent ICC - international convention center Van Rysselberghedreef 2 bus 1 - Citadelpark Ghent, Belgium 4 © 2013 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 978-90-574-0112-1 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 Despite progress in the care and treatment of mental health problems, the prevalence of violent incidents – verbal or physical aggression directed at self or others – remains high in many parts of the world. Violence towards staff is an occupational and public health issue and a serious threat to health services’ attempts to deliver quality care. Violence injures patients and staff, loses health services money as staff take time off to recover from injuries, harms the relationship between patients and staff, and damages services’ therapeutic nature. Staff are essential resources in providing quality mental health care but when they encounter violence they can suffer prolonged damage to their quality of life, and become suspicious and hostile in their work. Exposure to violence is a pre-disposing factor in the development of Post-Traumatic Stress Disorder in many people. Patients who witness violence on the ward are likely to abscond from fear, and may then be left untreated in the community with potential consequences of harm to themselves and others. Violence is not just a problem for clinical services in psychiatry; it has major social, political, security and judicial implications. Preventing violence, reducing its incidence and impact, managing its consequences and understanding how and why it manifests itself requires working across different disciplinary perspectives using the most up-to-date techniques and interventions and the best available evidence. Much is already known about violence in clinical psychiatry; much remains to be discovered. It is the latter of these issues upon which the 8th European Congress on Violence in Clinical Psychiatry will focus. The beautiful canal city of Ghent in Belgium is host to this year’s congress which sees a gathering of international academics, clinicians, managers and others with an interest in updating and sharing knowledge on the management of violence. As the papers in these proceedings show, this year’s congress is truly international. People from all corners of the world will deliver papers, symposia and workshops, present posters and debate how ‘new and interdisciplinary approaches’ might transform the landscape of violence research, education and practice. The concerns the congress addresses will be of interest and significance to people providing, using, developing and commissioning mental health and intellectual disability services, as well as the people who shape policies. For the first time the congress includes an expanded range of themes showcasing advances in the neurobiological, pharmacological, social, medical, psychological, cognitive and health sciences and their application to specific populations and topics. Presentations also reflect ethical and legal issues in addition to addressing racial, gender and ethnic perspectives. We are honoured at this year’s congress to welcome some of the leading international scholars who are at the forefront of thinking on violence in clinical psychiatry and beyond. Adrian Raine’s recently published work examining ‘The Anatomy of Violence’ sheds new light on how brain structures may underpin an individual’s propensity to commit violent acts. 6 His contribution to the congress will challenge notions about the role of free will and responsibility in the manifestation of violence and has far reaching implications about how societies respond to violent offenders. This is likely to be of particular interest to another of our keynote speakers Kelly McLean, a Registered Nurse who will present what is certain to be a moving account of her recovery from a violent assault while working in a psychiatric emergency room. Risk assessment is a widely used method of seeking to predict future violence with a view to preventing and minimising the occurrence of violence and managing people whose behaviour is deemed harmful. Henrik Belfrage’s work focuses on spousal violence risk assessment. The developer of the Brief Spousal Assault Form, Professor Belfrage examines the possibilities and pitfalls in spousal violence risk assessment and raises the question of which approach might be most useful. Restraint is a common method of managing violence in mental health settings. However, evidence shows that restraint has led to the death of patients on too many occasions. Joy Duxbury, chair elect of EVIPRG – the European Violence in Psychiatry Research Group – is one of the UK’s leading mental health nursing researchers and led a review of restraint- related deaths for the English Department of Health. Joy shares her insights gleaned from this review that will hopefully lead to practice changes that will eradicate these avoidable deaths. The keynotes papers conclude with three speakers from Belgium, this year’s host country. Kris Goethals discusses the role of uncontrollable sexual behaviour on violence, while Kurt Audenart examines how brain imaging studies in animals and humans help us understand the use and effect of serotonergic drugs in impulsive and aggressive patients. Christian Decoster from the Belgium Ministry of Health is a key player shaping national policy on violence in health settings. He will share his insights on the measures required to care for interned and other populations. It seems apt that the 8th European Congress on Violence in Clinical Psychiatry is taking place in the stimulating, idiosyncratic and authentic city of Ghent. We can think of no better setting for a lively three days of making discoveries about violence in clinical psychiatry, and making these discoveries matter to people’s health and well being. Professor Dr. Patrick Callaghan, School of Health Sciences, University of Nottingham, UK Dr Roger Almvik, Director of Research, St Olav’s Hospital, Trondheim, Norway and Chair of the European Violence in Psychiatry Research Group 7 Supporting Organisations The Congress organisation committee cordially thanks the following organisations for their support: • European Violence in Psychiatry Research Group (EViPRG) • Altrecht Aventurijn • CONNECTING, partnership for consult & training • Karolinska Institute • British Institute for Learning Disabilities (BILD) • World Psychiatric Association (WPA) Section on Art and Psychiatry Section on Psychiatry and Intellectual Disability Section on Stigma and Mental Illness • Universitair Ziekenhuis Gent • Vlaamse Vereniging voor Geestelijke Gezondheid (VVGG) • Ghent University • Psychiatrisch Centrum Dr. Guislain • Universitair Forensisch Centrum (UFC) • St. Olavs Hospital, Trondheim University Hospital • Geestelijke Gezondheidszorg Westelijk Noord-Brabant (GGZ WNB) • The University of Nottingham • Vlaamse Vereniging