Management of psychiatric in-patient violence: Patient ethnicity and use of medication, restraint and seclusion

Abstract

Background: Significant ethnic differences have been found previously on a forensic unit in the management of psychiatric patients after a violent incident. Aims: To study the management of violent incidents on all general wards in a large psychiatric hospital in South London. The main question is whether there are differences in the management of Black patients involved in violent incidents com pared with White patients and, if so, what are the factors leading to it? Method: All recorded violent incidents (1515 in total) on 14 general wards over three years (1994, 1996, 1998) were analysed using mixed logistic regression to estimate the odds ratio that the corresponding management decision (emergency medication, physical restraint, seclusion) was taken for Black patients compared with White patients after controlling for covariates and unobserved heterogeneity between subjects. Results: Black patients were more likely than White patients to be given emergency medication and to be secluded after a violent incident, but not to be physically restrained. However, differences disappeared when the odds ratios were adjusted for other variables. Conclusions: Racial 'stereotyping' was unlikely to have played a major direct role in determining nurses' responses.