Social contagion and environmental predictors of violent and aggressive behaviour
INTRODUCTION: Previous research investigating incidents of violence and aggression (V&A) within secure forensic settings have typically focused on individual factors of patients such as diagnosis and previous engagement in violent behaviour. The current thesis aims to complete an investigation of environmental effects which may influence rates of V&A within secure forensic mental health settings. A systematic review was undertaken to identify, synthesizes and evaluate the available research investigating environmental factors affecting rates of V&A within forensic mental health settings. Secondly an empirical study was completed which investigated the roles of temporal, meteorological and social contagion effects within a high security forensic hospital as they relate to rates of V&A. METHODS: A systemic search of relevant databases identified twenty-two studies meeting the pre-defined search criteria. The results of these studies were synthesised and discussed in the context of four groupings of effects: temporal & seasonal effects; meteorological effects; staff factors and ward characteristics. An assessment of the studies methodological quality was also completed. The empirical paper was a retrospective cohort study which will followed an observational cross-sectional design. Routinely collected data about incidents of V&A were collatedcollected between the dates 26/06/2012 to the 30/09/2021. This data was combined with available meteorological data. Temporal & meteorological effects were investigated using regression models., wWhile social contagion effects were investigated utilising a discreet Hawkes process. RESULTS: The results of the systematic review indicate that environmental effects areis a growing area of research interest which suffers due to inconsistency in the methodological strength of some of the studies. However, there is evidence to support the inclusion of temporal effects, staff factors and ward characteristics into dynamic risk assessments. The need to consider temporal factors was further supported by the results of the empirical study which found a significant day of the week, and time of day effect. These results are discussed in the context of typical routines of the study hospital. There currently exists insufficient evidence to comment fully on the effect of meteorological conditions as they relate to rates of V&A. The application of the Hawkes process provided some tentative evidence to support the theory that incidents of V&A are spread in part by a social contagion effect. CONCLUSION: The current thesis provides good evidence to support the use of the environmental factors within dynamic risk assessments, as there is clear evidence that the risk of V&A is not a constant entity, but instead fluctuates and is influenced by a number of environmental factors. Secondly, it is possible that an environmental effect such as shift change overs, medication distribution or being made aware of previous acts of V&A may be leading to increases in V&A. These findings may be significant in planning future hospital routines and systems to reduce the possible build of environmental pressures.