Aggressive Behavior in a High Security Ward: Analysis of Patterns and Changes Over a Ten-Year Period

The pattern of aggressive and violent behaviour in a maximum security forensic hospital ward, assessed by the Staff Observation Aggression Scale over a 10-year period is described. These results are compared to two other similar Norwegian projects addressing patient violence in a forensic hospital setting. Over 90% of patients had a primary diagnosis of psychotic, and 50% had a secondary diagnosis of personality disorder. Twenty percent of patients caused 80% of violent encounters, and most encounters appeared to result from limit setting actions. Only 36% of violence was viewed by staff as without clear precipitant. Female patients caused 50% more violent encounters than their representation among the patient population, but their violent behaviour was less dangerous and more often directed toward female staff than that of male patients. Overall staff were far more likely to be the targets of violence than other patients.