This paper describes the rate of violent episodes at a youth psychiatric unit, identifies significant clinical and demographic differences between service users who had admissions with violent episodes and those who did not, and describes characteristics of violent incidents, including antecedents, consequences, victim type, and severity of violence. A retrospective file audit over a 2-year period reviewed 303 admissions. Characteristics of violent incidents (n = 242) and service users (violent/non-violent) were recorded. Of 263 service users, 21.7% exhibited violent behaviour. Significant differences between admissions with and without violent episodes were found in terms of ethnicity, legal status, length of admission, and diagnosis. Staff were the most frequent victims and less severe incidents were most common. The most frequent antecedents to violence were positive symptoms of psychosis, hostility, and agitation, while the most common consequences were seclusion, physical restraint and 'as-required' medication. This study has identified that violent incidents are a common and significant issue. The findings might help staff in reviewing current management approaches. Future areas of study have been identified.

Traumatic brain injuries (TBI) can result in a variety of physical, cognitive, behavioural, and social changes for the survivor, which in turn impact on the lives of family members, relationships within families and family systems as whole. Traditionally, services have focused on the rehabilitation of the individual, but more recently there has been increased attention given to the provision of support and intervention for other family members. The present study describes family-focused therapy with five families, including the problems families encountered, how these were addressed in therapy, therapy outcomes and challenges therapists experienced. Therapy drew on a variety of models including behavioural therapy, family systems therapy and narrative therapy. Nine themes relating to issues experienced by families were identified, including: difficulties experienced were unexpected; increased anger, irritation and outbursts; challenges within marital relationships; family discord; changes to parenting and parent/child relationships; lack of motivation; lack of understanding from others; grief and loss; and negative experiences with helping professions. A varied approach to therapeutic intervention was required in order to accommodate the diversity of these issues. Analysis of standardized questionnaires revealed improvement on measures following therapy, with some deterioration at follow-up. Family members were generally satisfied with the service based on feedback questionnaires. Benefits of therapy described by families included having the space to talk and listen, survivors gaining increased insight, increased understanding from others, gaining increased acceptance, and the benefits of having professional input. The therapists identified a number of clinical and service-level challenges, but concluded that family-focused therapy can be a useful addition to the rehabilitation process following TBI.