Violence in forensic psychiatric facilities. A risk management perspective

Davide Ferorelli 1, Gabriele Mandarelli 2, Fiorenza Zotti 1, Stefano Ferracuti 3, Felice Carabellese 2, Biagio Solarino 1, Alessandro Dell’Erba 1, Roberto Catanesi 2

1 Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari “Aldo Moro”, Bari, Italy; 2 Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari “Aldo Moro”, Bari, Italy; 3 Department of Human Neurosciences, Sapienza University of Rome, Italy

Violence against healthcare workers is a global phenomenon. Psychiatric settings are among the places at greatest risk of being a victim of aggression. Several strategies aimed at preventing violence in healthcare settings and implement protective measures have been proposed. Nevertheless, forensic psychiatric settings have been poorly investigated from the point of view of clinical risk management, especially in Italy. The recent process of deinstitutionalization of forensic psychiatric patients in Italy, with the replacement of former forensic psychiatric hospitals with small regional-based community structures (REMS), deserves particular attention in terms of clinical risk management. We propose in the following contribution a methodology that allows to measure the risk of violent behavior in different psychiatric forensic settings, from the point of view of clinical risk management. This includes a proposed adaptation of the Modified Overt Aggression Scale (MOAS) for the specific purpose. The use of such approach, including the calculation of a structure’s “risk score” could allow comparisons between different facilities as well as the implementation of strategies aimed at minimizing the frequency of violent acts, as well as activating the most suitable measures to prevent them.

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