Aggression in specialist secure and forensic inpatient mental health care: incident across care pathways

Purpose - To describe how aggressive and violent incidents differ across specialist gender, security and mental health/ learning disability pathways in specialist secure care. Design/methodology/approach - A retrospective survey of routinely collected incident data from one 207-bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability. Findings - In total, 3,133 incidents involving 184/373 (49.3%) patients were recorded (68.2% other-directed aggression, 31.8% self-harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self-harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway. Research limitations/implications - Incidents, especially those of lower severity, can be under-reported in routine practice. Information about incident severity was limited. Practical implications - Aggressive incidents do not occur homogenously across forensic and secure mental health services but differ substantially in their frequency and nature across security levels, and gender and mental health/ intellectual disability pathways. Different approaches to training and management are required to ensure appropriate prevention and intervention. Future practice should draw on emerging theories of differential susceptibility. Originality/value - This paper extends current knowledge about how incidents of violence and aggression differ across secure settings