Violence in psychiatric hospitals usually triggered by staff, not patients. International study findings.

Violence in Psychiatric Hospitals Usually Triggered by Staff, Not Patients. 


Note: Comments of people who have been placed in psychiatric facilities and later recovered—in spite of psychiatric treatment, not as a result of it.


I was physically abused/assaulted in a psychiatric hospital in the late 70s. The staff where I was placed in the late 80s and as recently as 2005 are rude, talk down to patients, have a lot of emotional problems themselves, little if any compassion or empathy, and in my opinion, trigger a lot of the violence in the State hospitals.

– Dennis Dodson, Mental Health Advocate


A study of the causes of violence in psychiatric hospitals was quite revealing. The majority of violent and aggressive incidents are triggered by staff members, not by patients. Considering the fact that nearly all the reports were written by staff members, one must wonder if the truth is even worse.


Published in Acta Psychiatrica Scandinavica, “The antecedents of violence and aggression within psychiatric in-patient settings” summed their results:


  • The majority of violent and aggressive incidents across in-patient psychiatric settings are triggered when staff interact with patients.
  • Staff more readily record patient behavioural cues as antecedents compared with mood ⁄ emotional cues.
  • When staff is unsure of what precipitated an incident, they should pursue other potential sources of antecedent information.

I have seen and had therapists call me and other patients horrible names, and make fun out of us when they thought no one was listening. It’s not physical violence—but being called names and told you *are* no good, and what not—that not only hurts, but how do you get better?

–Susan Schechter – If You’re Going Through Hell Keep Going 


To be included, a study had to be peer-reviewed, produced in English between 1960 and 2009, and focused on aggressive behavior of non-geriatric adults in psychiatric facilities. After reviewing hundreds of studies, the authors selected and examined 71 that had been produced in 13 countries:


  • USA, 21 studies
  • UK, 19 studies
  • Australia, 7 studies
  • Norway, 6 studies
  • Sweden & Canada, 4 studies each
  • Italy, 3 studies
  • Taiwan, 2 studies
  • Denmark, Finland, Germany, Netherlands, & Singapore, 1 study each

I saw plenty, and it was always, without exception, brought on by a staff person who was poorly skilled in how to speak with someone who was in deep distress, and frequently by staff people who were just awful—pushing people around, asserting their “power”, imposing arbitrary rules, various injustices, is how I would sum it up.

Amy Smith


Because several different approaches were used in the studies, including different ways of reporting, it’s difficult to develop a cross-study indication of how much aggression and violence is preceded by staff, rather than patients. Only 7% of the studies captured information from the patients’ point of view. Nearly all the information was provided by staff members without consultation with patients.


… he was bullied on a 3 day hold a few years ago, where not only did they insult him, he has nightmares about what the doctors and therapists said. He calls it mind rape


46 of the 71 studies showed that “staff-patient interactions” preceded aggressive and violent incidents the most.


Of the 25 that didn’t, 6 studies blamed “patient symptoms” and 11 blamed “no clear cause”.


“Patient-patient interaction” was given as the primary reason in 3 studies,


“Patient behavioral clues” in 3 studies,


“Structural issues” in 1 study.


One other study divided the results between what staff thought (“patient symptoms”) and what patients thought (“no clear cause”).


Overall, the studies reported anywhere between 13% and  82% of aggressive or violent incidents were preceded by “staff-patient interaction”.


One day I was in my room and a nurse opened the door and walked in. Her intent was to check my glucose level before supper. She got her machine all set up and ordered me to do this and that to cooperate with her agenda. I got pretty snappish and uncooperative. She had some bad words to say about my attitude and I likewise about hers.


What she utterly ignored was that she had entered my room without knocking and left the door open—and I was standing there exposed, wearing only a T-shirt and underpants while all the passersby were fully clothed.


 Anne C. Woodlen – Notes in Passing 


The study showed that 47% of all aggression-violence cases in acute facilities were preceded by staff-patient interactions, and was the most prevalent cited. In acute facilities, patient-patient interaction was given 25% of the time, patient conflict behaviors was 3%, patient symptoms was 33%, and no clear cause was given in 27% of the cases. One must ask how the patients view this.


The simple fact is that these facilities are not generally ones that people choose to enter of their own accord. They are locked, loaded with rules, highly crowded, horrifically boring, and inherently demeaning. That any study in which staff members provide most of the information could show staff responsibility for more patient violence than any other cause is astrounding when the reporting is done by staff members. How much worse is it?


The authors suggest:

Such findings underscore the influence that staff have in making wards safe and efficacious environments. It also suggests that most violent incidents are preceded by the staff exercising their power over the patient. Such findings underscore the influence that staff have in making wards safe and efficacious environments. It also suggests that most violent incidents are preceded by the staff exercising their power over the patient.


The patients are basically housed and herded from one place to another for “activities”. There’s basically NO services provided. Just dope um up and keep um where they’re supposed to be. Patients spend a lot of time sitting and watching TV.


The medications prompt confusion and violence in a lot of patients also. Couple that fact with rude and smart mouthed workers and you have a recipe for violence and people becoming regulars at the State Hospital.


Dennis Dodson –  Mental Health Advocate


Clearly, even if there is a goal of providing safe haven for psychiatric patients, there’s little effort to reach it. The study also documents a previously known fact, that violence is more common in locked facilities. While that may not be surprising, it clarifies that any claim of such facilities existing for the benefit of patients is inherently false.


Psychiatry has clearly become a corrupt field:


  • Its basic diagnostic manual, the Diagnostic and Statistics Manual (DSM), which determines what constitutes a diagnosis, is created by a vote of psychiatrists, the majority of whom take money from Big Pharma. Thus, diagnoses are by popular vote of a bunch of bought-and-paid-for shrinks.
  • The basic concept used to support their treatments is a complete fraud. They claim that all the diagnoses in their DSM are brain diseases, and that these diseases are the result of chemical imbalances. It is completely untrue and all the efforts to prove it have fallen flat.
  • The primary treatments used by psychiatry—psychoactive drugs, electroconvulsive therapy, and modern-day lobotomies masquerading under new names—are largely fraudulent and horrifically harmful. They destroy health and lives. Yet, psychiatrists have the power, which they use with reckless abandon, to force these treatments on people.

On a different inpatient unit, I had requested—appropriately, respectfully and repeatedly—a meeting with a unit administrator. He kept promising to meet with me but failing to do so. It got to be late Friday afternoon. The issue really needed to be addressed before the weekend and I strongly suspected that he was going to slip out the back door without seeing me, so I went and sat on the floor (there being no chairs) in front of his office door. I neither said nor did anything; I simply sat.


Staff members came and dragged me away. I went limp and made no effort to resist. They manhandled me so severely that I was left with bruising on my arms.


All it takes to avoid conflict is for the staff members to treat the patients with respect.


Anne C. Woodlen – Notes in Passing 


On top of all that, they routinely confine people in psychiatric facilities, which are clearly mistreating people and have no track record of curing them—and doing so by force.


As this study and the comments included quotes from patients, there cannot be much genuine intent to help the people caught up in their web. Psychiatry is a system that is based on an inherent lie, that creates its own diagnostic manual on the basis of a popular vote of people corrupted by Big Pharma, and that utilizes treatments of little or no benefit and enormous harm.


Isn’t it well past time that these abuses be ended?



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