Evaluation of a new record system for aggressive incidents in mental health services

Amid growing concern about violence in mental health services, good information is needed for individual care planning and service planning. Existing systems for the routine recording of aggressive incidents suffer from underdetection, poor reliability, and have little value in care planning. The Overt Aggression Scale (OAS) and other similar measures overcome some of these difficulties. These measures are reviewed, and it is concluded that the OAS has acceptable reliability and validity, and no other similar measure significantly improves upon it. However, the OAS records no information on the setting events, antecedents or consequences of aggressive incidents- all of which are essential for effective prevention and management. A new scale, the Aggressive Incident Record Form (AIRF), was therefore devised, incorporating main features of the OAS, and including information on setting events, antecedents and consequences. The AIRF was piloted and evaluated. Its face validity, concurrent validity and inter-rater reliability were all high. Staff using the AIRF found it easier and quicker to complete than existing documentation, and overall they reported that the information captured was more useful in care planning than that captured by the existing sources. There is a need for further study, and perhaps improvement, particularly regarding the clarity of the instructions for the AIRF.