Reducing Institutional Violence

Violence is an ongoing problem in state hospitals, where staff supervise and treat distressed adults who are detained against their will, restricted in their activities, and often involved in the criminal justice system. Current violence prevention strategies focus on managing a small group of high-risk patients. According to leading theories and some evidence, strategies must be broadened to target organizational climate, authoritarian relationships, physical blind spots, and other institutional factors to maximize violence prevention.  Environmental factors that engender a sense of injustice, disrespect, and deprivation can provoke violence even among low-to-moderate risk patients.

At Napa State Hospital, we are identifying institutional risk factors that most robustly predict variation in violence rates across hospital units.  More importantly, we are testing whether an intervention that specifically target a unit’s institutional risk factors adds value in preventing violence.   Results will help inform system-wide change in one of the country’s largest hospital systems.