Testing the predictive utility of institutional risk factors for violence

State hospitals across the country are looking for innovative ways to prevent violence.  In these institutions, staff care for people with mental illness who are detained against their will.  Violence is a serious problem–and prevention is essential to providing excellent services that promote safety, health, and wellness.

Traditional prevention strategies focus on patients as the source of the problem. We broadened the focus to consider the environment. “Distressed and disordered people are not violent merely because of who they are, but because of where they are – and how they are treated” (Cooke, 2019).  In theory, environments that create a sense of deprivation, unfairness, stress, and disrespect can promote violence.

We partnered with the California Department of State Hospitals (DSH) to test the contribution of institutional risk factors to violence. We found that environments matter.  Hospital units differed in features like the quality of staff-patient relationships, staff training and competencies, and physical security factors — and these differences robustly predicted units’ future rates of violence.  

Now, we are working with DSH to test whether environments can be improved to move the needle on violence prevention. See our page Changing institutions to prevent inpatient violence.