Resource consumption in psychiatric intensive care: the cost of aggression

Previous reports have suggested that the level of serious violence In psychiatric patients Is low (Pearson et al, 1986). However, there Is now concern that the level of violence Is Increasing (James et al, 1990; Omérovet al, 1990). Violence has obvious undesirable effects (eg. Increased staff and patient stress and a generally poor atmosphere on the ward), and may also be associated with altered staff attitudes towards, and poorer outcomes for, violent patients (Karson et al 1991). Psychiatric Intensive care units (PICUs) have been set up to provide better care for this small group of highly disturbed patients (Hyde & HarrowerWilson, 1994). It has been estimated that aggression Increases the cost of care, with violent schizophrenics costing 43% more to treat than non-violent schizophrenics (Karson et al 1991). O'Dwyer & Mann (1989) described a 15-bed psychiatric Intensive care ward (PICU) with an annual budget of £202,386, but there is little information published on the breakdown of costs. The prospective study presented here measured the total costs of such a unit for six months, differentiating between fixed and variable costs and estimating the additional cost Incurred by violent patients. The study