Most patients (including inpatients) with mental illness are not violent. However, there is an increased risk of violent or aggressive behavior associated with some psychiatric illnesses including schizophrenia and bipolar disorder. In 2013, the California Department of State Hospitals (DSH) recognized that inpatient violence within the state hospital system (which includes the Atascadero, Coalinga, Metropolitan, Napa, and Patton hospitals) was at an alarming figure (9449 acts of either patient-patient or patient-staff violence). The DSH therefore began to increase efforts to reduce violence including enlisting the help of the Neuroscience Education Institute (NEI) and a panel of expert mental health professionals from around the state of California to develop a set of assessment and treatment guidelines. Since the publication and implementation of these California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines in 2014, the number of violent acts has been significantly reduced by approximately 34% (6231 violent acts in 2014 and 6344 violent acts in 2015) across all hospitals. This reduction is most prominent in terms of severe violence and most especially in terms of patient-staff violence.

This is great news, not only in terms of 3,000 fewer violent acts occurring each year, but also in terms of the impact that guidelines in general can have on patient and practice outcomes. The World Health Organization has recently reported that depression is the #1 cause of disability and poor health worldwide (see previous TMIP article); some of this issue may in fact be due to the unrecognized presence of mixed features in patients presenting with symptoms of depression. Fortunately, NEI (along with a panel of the top 20 mood disorder experts from around the world) has just published a set of guidelines for the recognition and treatment of depression with mixed features. We look forward to seeing the impact that these mixed depression guidelines may have on outcomes for patients with depression.

>> Reports and Data. California Department of State Hospitals.

References:

Stahl SM, Morrissette DA, Cummings M et al. California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines. CNS Spectr 2014;19(5):449-65.

Dardashti LJ, O'Day JA, Barsom MW et al. Illustrative cases to support the Cal-VAT guidelines. CNS Spectr 2015;30(3):311-18.

Stahl SM, Morrissette DM, Faedda G et al. Guidelines for the recognition and management of mixed depression. CNS Spectr 2017; Epub ahead of print. (Open Access)