Psychiatric Press, 2nd edn. Distributed through Eurospan London WC2E 8LU. Sep 1996 125pp. Paperback ยฃ15.95 ISBN 0-88048-344-X.
Although all health service workers may from time to time encounter aggression or violence from a patient, psychiatrists and other health workers are likely to be particularly vulnerable. Dr Kenneth Tardiff, in the second edition of his book provides succinct and practical answers to the numerous questions in this field.
There are eleven chapters, covering causes of human violence, clinical safety, seclusion and restraint, use of emergency medication, extended evaluation of violent patients, long-term medication, long-term psychotherapy, behaviour therapy, short-term prediction of violence and legal issues in the management of violent patients. Each chapter has useful tables providing information at a glance. As far as possible advice is founded on research evidence. The chapter on causes of human violence, for example, offers information from research on how innate, developmental, socio-economic and physical environmental factors may interact to tip the balance away from an individual's ability to achieve goals by non-violent means.
The chapter on clinical safety provides guidelines for verbal intervention in emergencies, offers advice on how to set up an environment to minimise risk and facilitate negotiation and ends with a specific note on dealing with a patient who has a weapon. A key issue in the seclusion and restraint material is its prevention, but, if unavoidable, guidance is offered about accomplishing these interventions safely. One valuable point he makes is that often, perhaps generally, the staff involved in such techniques will be involved in longer term management. Effective restraint must therefore incorporate techniquesincluding continuing reassurance and explanations -that will maintain the possibility of a therapeutic relationship. The use of medications is extensively reviewed, both for an emergency and to maintain longer term safety.
The chapter on extended evaluation, contains a brief but comprehensive approach to formal medical assessment, but also emphasises the input of other disciplines including psychological, particularly neuro-psychological assessment. Current knowledge about interactions between various categories of mental disorder including substance/alcohol related disorders, and violence is incorporated in this chapter. In the two chapters dedicated to long-term psychotherapy and behaviour therapy respectively, issues of patient selection, goals of treatment and precautions needed to protect the therapist are raised, and observations are offered on the skills required in order to avoid perpetuating an already existing potential for violence.