Aims and MethodAssaults in healthcare settings have resulted in a range of national strategies aimed at reducing the incidence of violence. This study aimed to quantify the use of prosecution of assailants as a response, and to examine what other responses were used. the responses to violent incidents in three Northern Ireland psychiatric in-patient units in the year 2003 were ascertained retrospectively.ResultsOf 245 incidents meeting the legal definition of assault, police were contacted in 10, and 1 resulted in a prosecution. Seven in-patients accounted for 30.4% of assaults. of the assaults, 46.5% were dealt with by staff using de-escalation alone.Clinical ImplicationsThese results demonstrate the infrequent reporting of such assaults to the police. A more structured approach should be taken to this important decision. Factors relating to the prosecution of assaults in psychiatric in-patient units are discussed.

The case illustrates a delicate imbalance between dose of neuroleptic medication and depressive symptoms. We should be aware of the possibility of mood changes in patients treated with neuroleptics for a variety of conditions.