Patient-staff conflict: results of a survey on acute psychiatric wards

Background: Disruptive behaviours of acute psychiatric inpatients have typically been studied separately, as have the methods used to contain them. There are indications that behaviours and containment methods are systematically related. Aims: The aim of this study was to assess the frequency and relationship between the differing conflict behaviours of patients, and explore the relationship between professional containment measures and those conflict behaviours. Methods: A cross-sectional survey of conflict behaviours and containment of 238 two-week admissions to 12 acute psychiatric wards in London, UK was carried out. Results: Factor analysis revealed seven patterns of conflict behaviours, with aggression being separately associated with absconding and medication refusal. Neither substance misuse nor self-harm were associated with aggression. Aggressive behaviour attracted the widest range of containment measures, including the use of special observation. Conclusions: The conflict behaviours of patients form complex patterns, and should be studied together rather than separately.