[Managing aggression in a forensic psychiatric unit for adolescents: literature review and clinical implementation]

Aggressive incidents are part and parcel of everyday life in a forensic psychiatric unit for adolescents.status: publishe

Agressiebeleid op een forensische psychiatrische unit voor adolescenten : literatuuroverzicht en implementatie in de praktijk

status: publishe

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.status: publishe

Forensische pilootprojecten ‘medium security’:Incidenten tijdens behandeling van geïnterneerden ressorterend onder CBM Gent

Research concerning forensic medium security units in Flanders is scarce. This study reports on incidents during treatment. The population consisted of 203 forensic patients conditionally released by the Commission of Social Defense (CPS) of Ghent. During a ten-year follow-up period 236 incident reports were registered, caused by half of the population (53.20%). Less than half of these reports (41.53%) concerned incidents coded as criminal offences (like drug use, theft or violence). Violent incidents occurred in one out of five reports (20.34%) and were associated with poor treatment compliance and failure. Victims of violence were mainly hospital staff or patients. Incidents were reported to the prosecutor, but rarely led to a new conviction or internment. Instead, one third of the population was (re)incarcerated in prison. Protection, rather than treatment, thus seems to be the primary focus of the CPS