The frequency of inpatient violence in patients admitted for risk of violence to an acute psychiatric hospital in South Africa

Tippoo, Joshua

The frequency of inpatient violence in patients admitted for risk of violence to an acute psychiatric hospital in South Africa

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

Background: Involuntary admission of psychiatric patients assessed as posing a risk of violence is common practice. Assessment of this risk may, however, be inaccurate, and it is not clear if, during their admission, these patients display violence more than others. If not, some of these admissions might be considered unjustified infringements on individual human rights and a poor use of health system resources. Aim: This study aimed to investigate violence and related phenomena (VRPs) in involuntary psychiatric inpatients, and their association with admission risk profile and other demographic and clinical factors. Setting: This study took place at Valkenberg Hospital, a tertiary psychiatric hospital in Cape Town, South Africa. Method: A retrospective folder review of one month's consecutive admissions (n=140) examined the association between being assessed as at risk of violence and subsequent VRPs. Associations between VRPs and other demographic and clinical factors were also investigated. Chi-square tests and independent sample t-tests were used to test statistical significance. Results: Most patients (81.4%) were admitted for being assessed as at risk of violence. This assessed risk was not significantly associated with the presence of VRPs (RR=2, p=0.075) nor an increase in frequency of VRPs (t=0.5,1p=0.31). Substance users, however, had a significantly increased frequency of VRPs (t=2.15, p=0.017) compared to non-substance users. Conclusion: Being assessed as at risk of violence on admission showed no statistical association with VRPs during admission. This suggests some involuntary admissions may be unjustified, but higher-powered studies are required. Substance use contributed to increased VRPs in our setting.