Eric Lim

In acute mental health settings, it has been reported that almost one in five consumers may display aggression (Iozzino et al., 2015). Consumer aggression is commonly recognised as an unwanted behaviour that can cause injury to self and/or others, or cause serious damage to property (NICE Guidelines, 2015; Lim et al., 2019). Literature identifies that aggression by consumers is commonly related to 1) personal factors (acute symptomatology, substance intoxication, previous trauma, serious personality disorder); 2) external factors (involuntary admission, crowded space, ward restrictions); and, 3) interpersonal factors (poor communication, misunderstanding, conflict) (Bowers 2014; Dickens et al. 2013; Duxbury & Whittington 2005).

The high rate of consumer aggression can impact on the quality of care delivered and increase Service expenditures. For example, through the use of higher staff-to consumer ratios and extended length of stay to support consumer recovery (Abderhalden et al. 2007; Blando et al. 2013; Bowers et al. 2009; Hahn et al. 2006; Heckemann et al. 2015). The high rate of consumer aggression can give rise to direct or vicarious impacts on staff’s psychological and emotional wellbeing. The literature highlights that staff who have experienced or witnessed consumer aggression are likely to develop negative feelings such as sadness, anxiousness, demoralised, or a sense of being victimised having to care for that individual. Staff who were repeatedly exposed to aggression at work can also perceive themselves as professionally incompetent to care for people with a mental illness, or lose their passion of why they want to work in mental health settings (Bowers et al., 2006; Currid, 2009; Flannery Jr et al., 2011; Inoue et al., 2006; Whittington & Richter, 2006). Staff who were concerned about their personal safety can become hypervigilant, distrustful, and fearful towards the individual and possibly interact less frequently with the consumers (Lim, 2010). This can result in the use of stricter management plans and restrictive practices prematurely. For example, engaging security guards to provide close observation, enforcing sedative medications, or intervening with restraints and seclusion when verbal de-escalation may be effective if initiated early (Bowers et al., 2002; Hallet et al., 2014; Lim, 2010; Paterson & Duxbury, 2007). Ultimately, staff who cannot deal with the experience of consumer aggression will utilize sick leave, workers’ compensation, request a transfer to another mental health unit, or resign from the Service (Edward et al., 2014; Flannery Jr et al., 2007; Kindy et al., 2005).