A Ten-Year Study of Assaults and Assaulters on a Maximum Security Psychiatric Unit

Assaults committed by psychiatric patients have recently attracted considerable attention. Available data, however, indicate disagreement as to the characteristics of assaults and assaulters in mental health facilities. Several methodological problems that may explain this lack of agreement are identified. Over a 10-year period, exhaustive records of all physical assaults and all attempted assaults were gathered on a maximum security psychiatric unit. The data were gathered prospectively, and the study established interrater reliabilities and did not rely solely on regular institutional records that are known to underrepresent institutional assaults. Results indicate that assaults increased throughout the study period despite clinical and administrative efforts to reduce them. Assaultive patients represented a small fraction of the study unit's population and they were younger, more psychotic, had longer stays in maximum security, and had poorer preadmission community adjustment than nonassaultive patients. Assaulters were also more likely to have been referred from other psychiatric settings and less often had criminal charges. Generally staff and patients showed low agreement as to the reasons for assaults. Evidence and present data show that staff training and institutional monitoring practices can reduce patients' assaultive behavior.