Measuring aggression in mental health patients

A tool developed by Swinburne researchers to measure the risk of aggression in mental health patients is being adopted internationally to help prevent hospital violence.

According to 2014 figures, more than one in three Victorian mental health workers were physically assaulted and four out of five nurses were attacked verbally, physically or sexually within the previous 12 months. Figures from the UK show nearly 50,000 assaults in mental health and learning disability units over a similar period.

But up until recently there was little staff could do to predict imminent violence, beyond relying on their gut instincts.

Innovative research led by clinical psychologists, Professors James Ogloff and Michael Daffern, of Swinburne University of Technology’s Centre for Forensic Behavioural Science is now addressing the need to assess when a patient is likely to become violent.

“Although we need to keep in mind a patient’s history of violence, the best way of determining someone’s risk in the next 24 hours is to look at their current state, and we do that by looking at their presentation over the past 24 hours,” says Daffern.

The seven-item Dynamic Appraisal of Situational Aggression (DASA) was developed in 2006 following a six-month study to identify and test the predictive accuracy of numerous risk factors for patient aggression. The factors that were most strongly predictive of imminent aggression were negative attitudes, impulsivity, irritability, verbal threats, sensitivity to perceived provocations, angering easily when requests are denied, and unwillingness to follow directions.

Trials in Victoria showed that the DASA, which takes nurses only a few minutes to complete, has greater reliability and predictive accuracy than the previous ad hoc methods.

In the decade since its development, DASA has been adopted by mental health units from New Zealand to the US, Singapore, Hong Kong and Canada. Most recently, the United Kingdom’s leading agency advising on clinical practice, the National Institute for Health and Care Excellence (NICE), endorsed it as one of only two methods for predicting imminent violence. “That level of endorsement has created a lot of interest,” says Daffern.

He and Ogloff are now working on an online application that will enable staff to use DASA electronically and link the risk assessment to preventative strategies. The application is due to be launched this year and will include the ability to track which interventions are most effective in preventing violence on a patient-by-patient basis. 

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