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Friday, 21 April, 2000, 00:02 GMT 01:02 UK
Psychiatrists 'don't ask about violence'
Pscyhiatric unit
One in ten psychiatric patients own a weapon
Despite high profile murder cases involving psychiatric patients, doctors are not asking them about their violent thoughts, say researchers.

The failure to ask them about their intentions to commit violence could be putting the public and patients themselves at risk, a report says.

Dr Steven Milne claims in the British Medical Journal (BMJ) that only 13% of psychiatric patients he studied had been asked about their thoughts of violence towards others.

Guidelines requiring psychiatrists and other members of their teams to ask patients and record information have been introduced following cases such as that of Jonathan Zito who was killed by a care in the community offender seven years ago.

But the study of almost 100 psychiatric patients admitted to St Luke's Hospital, Middlesborough, suggested this is not happening in practice.

'Suicidal thoughts'

Dr Milne asked patients whether they had thought about suicide, damaging property and violence towards other people in the past week. This was then compared to the number of patients who had been asked about this by the medical team treating them.

Almost half said they had had suicidal thoughts, and a quarter had considered violence towards specific people.

Nearly one in ten admitted owning a weapon and one in 20 to carrying one, both of which are recognised risk factors for violence.

Over half of patients had a history of violent behaviour.

But though the clinical team nearly always asked their patients about suicidal thoughts, only 2.5% asked about damage to property and 13% asked about thoughts of violence towards others.

Half of patients had considerd suicide in the past week
Dr Milne said in the BMJ: "Thoughts of violence to self among patients admitted to psychiatric hospital were common and were asked about by the teams who admitted them.

"Other violent thoughts were also commonly encountered, yet clinicians asked about them infrequently."

Dr Jenny Shaw, of Guild Community Health Care Trust, in Preston, said it was important to ask about violent thoughts but further inquiries were needed.

And she said politicians were too quick to assume that it is possible to predict violence in psychiatric patients.

Dr Martin Deal, a consultant psychiatrist at Honerton and St Bartholomew's Hospitals in London, said he was "very surprised" by the findings.

'No complacency'

"In the light of a large number of care in community tragedies, most hospital trusts now have formal protocols.

"In Hackney we have a large number of potentially troublesome patients, so every patient is asked about violence continually."

He said the study, if it was correct, showed "there could be no grounds for complacency". Psychiatrists should have "a high index for suspicion".

Questioning should, however, be tailored to the individual patient - it was inappropriate for example to ask an elderly woman suffering from depression about plans to commit violence.

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See also:

13 Oct 99 | Health
Suicidal 'failed' by NHS
13 Oct 99 | Medical notes
Personality disorder
20 Aug 99 | Health
Psychiatric services 'failing'
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