Patients on secure wards are more likely to be aggressive towards staff of their own sex

Secure ward managers may be able to reduce patient aggression by carefully monitoring the sex ratio of the staff relative to the patients. That's according to Susan Knowles and colleagues who've found that mental health patients held on a medium secure ward were more likely to exhibit physical or verbal aggression to staff of the same sex as themselves.

The researchers analysed incident report records kept between 2004 and 2006 by two male-only and two female-only wards at a medium secure unit in the North West of England.

During this time, 192 physical acts of aggression by patients were reported - 84 on the male wards, 108 on the female wards. One hundred and sixty-five cases of verbal aggression were also reported - 82 on the male wards, 83 on the female wards.

Crucially, these aggressive acts were far more likely to occur between patients and staff of the same sex. For example, 64 per cent of male physical aggression was against male staff, while 70 per cent of female physical aggression was targeted at female staff.

The situation is complicated by the fact that many more male staff work on male wards and vice versa for female wards. However, statistically controlling for this bias showed that male patients were still significantly more likely to be aggressive towards male staff and female patients more likely to target female staff.

Knowles team said their findings could be interpreted in terms of an effect / danger ratio - people are more likely to be aggressive if they think their desired effect can be achieved with the least danger to themselves. By this account, men avoid aggression towards women because of the likely social censure that will ensue, whereas women will avoid targeting men because of their tendency to have greater strength. Evolutionary psychological theory also predicts that men will target other men, rather than women, because of competition for resources and partners.

The findings have obvious practical implications. The researchers said more opposite-sex staff should be introduced on secure wards. "This may reduce aggressive behaviour by simply reducing the number of potentially appropriate targets," they said. However, they also cautioned that there could be a risk of aggressive behaviour being targeted at the remaining same-sex staff, rather than diminishing overall, so any staffing changes should be "closely monitored".
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Susan Knowles, Sarah Coyne, Stephen Brown (2008). Sex differences in aggressive incidents towards staff in secure services Journal of Forensic Psychiatry & Psychology, 19 (4), 620-631 DOI: 10.1080/14789940801962130

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