Observational study of aggressive behaviour and coercion on an Indian acute ward

• Aggression in Indian psychiatry wards appear to be higher compared to European settings.
• Presence of relatives on wards shifts the target of violence from staff to relatives.
• Relatives are a significant resource in the management of incidents.
• Aggression towards staff is more likely to lead to coercive measures.

ObjectiveWe evaluated prevalence of aggressive behaviour and coercive measures on an acute Indian psychiatric ward where relatives are always present at the ward.MethodNon-interacting, independent observers (specifically trained mental health clinicians) on an Indian acute, 20-bedded psychiatric ward gave structured reports on all violent episodes and coercive measures during a 30-day period. They used the Staff Observation Aggression Scale −Revised, Indian (SOAS-RI). The severity of the SOAS-RI reports were independently analysed by one of the authors.Results229 violent incidents were recorded, involving 63% of admitted patients. 27% of all admitted patients were subjected to intravenous injections. Relatives provoked 35% of the incidents and were the target in 56% of the incidents. Patientś own relatives were involved in managing the aggression in 35% of the incidents. Relatives of other patients were involved in 14% of the incidents. The likelihood of a patient to be physically restrained and that a relative would be participating in the coercive measures was increased when medical staff was targeted.ConclusionRelatives are commonly triggers and victims of aggressions on the inverstigated acute Indian psychiatric wards. Doctors and nurses are less likely to be victims but aggression towards them leads more commonly to coercive measures.