Dr Dominic Beer was a consultant psychiatrist in a psychiatric intensive care (PICU) and challenging behaviours unit. He was one of the founding members of National Association of Psychiatric Intensive Care Units (NAPICU), bringing a great contribution to the discipline of psychiatric intensive care and challenging behaviour. He chaired the working group that developed this text.
The working group was multidisciplinary and included psychiatrists from forensic, older adult, learning disability, and general adult specialties as well as colleagues from nursing, psychology and pharmacy backgrounds.
The book came as a result of revising relevant aspects of three previous documents produced by the Royal College of Psychiatrists (1995, 1998, 2000) on the management of violence and the appraisal of new evidence since the publication of National Institute for Health and Care Excellence (2005) guidelines on the short term management of disturbed or violent behaviour in psychiatric inpatient settings and emergency departments.
The authors have produced and summarised multidisciplinary guidelines targeting both individuals and organisations, to prevent and manage aggression and violence of patients with mental disorders, in accordance with relevant legislation and national best practice guidelines.
Throughout the 13 chapters, relevant issues and recommendations related to the topic of aggression and violence are identified and briefly detailed for a better, holistic understanding and clinical practice. These include: different legislation related to the management of violence by persons with mental disorders; safeguarding issues; risk assessment, management and prevention; post incident management; non pharmacological and pharmacological management of violence in acute settings as well as in the community, in older adults, in prisons and in people with intellectual disability; it also discusses liaison with other relevant agencies.
PICU staff and other mental health professionals may gain from the explanatory passages, which have been written clearly and in brief, making them easy to read and time-efficient.
I found this book to be a welcoming refresher for professionals working with this patient group, and was prompted to reflect on the fact that violence and aggression may not be directly or solely related to the mental disorder; a more holistic consideration including social, environmental and physical distress is required. Aspects of managing aggression (such as likely social and environmental causes) can be sometimes overlooked, and the authors direct interventions towards non-pharmacological techniques with higher rates of efficiency, rather than medication. However, some mental illnesses surely predispose patients to having a lower threshold for frustration, which can be linked to potential violence.
Whilst not new, and by no means replacing any textbook, this volume is easily readable, understandable and addresses such sensitive issues as violence in patients from minority ethnic backgrounds, ways to apply physical and pharmaceutical methods of restraint safely and preserving patients’ dignity in highly volatile situations, as well as keeping in line with sound policy.
In sum, I highly recommend this book to students interested in a career in mental health services, as well as to established mental health practitioners.
