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”.

ResearchBlogging.orgSusan 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

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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

  1. interesting, but having worked in mental health unit briefly ( in a non clinical capacity) I wonder if these results reflect a tendancy of , say, male staff to report incidents of aggression by males more than by females. The decision to report is a subjective one and perhaps there are different reporting thresholds.

  2. I am just speculating and making a guess, but do people act out violence to others of the same gender as sort of a reverse modeling (in a Bandurian sense)? Especially if they are on the ward with suicidal ideations? I guess you could also term it as projection.

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