Psychological framework to understand interpersonal violence by forensic patients with psychosis: commentary, Huang & Wei

Lambe et al's paper¹ in the BJPsych provides a profound insight into the psychological underpinnings of violence in psychosis, contributing significantly to our understanding and management of such behaviours in clinical settings. In our work in Taoyuan Psychiatric Center in Taiwan, we have had first-hand experience dealing with patients exhibiting violent behaviour due to psychosis. We appreciate the effort to delineate a seven-factor model elucidating the complex interplay of learned behaviour, sensitivities to disrespect, threats, unfairness and the escape from psychotic experiences leading to violence.

Our experience at Taoyuan Psychiatric Center, particularly through the application of team resource management (TRM) to mitigate incidents of violence against psychiatric healthcare staff by patients,² aligns with several aspects highlighted in Lambe et al's study. Our approach, focused on enhancing team coordination, leadership, situation monitoring, mutual support and communication, echoes the importance of a multifaceted strategy in managing violence in psychiatric settings. The incorporation of TRM led to a notable reduction in incidents of physical aggression towards staff, emphasising the potential of team-based interventions in enhancing patient and staff safety.²

However, our findings also underscore the critical role of systemic and organisational measures in addressing violence. Although individual psychological processes are undeniably crucial, our interventions demonstrated that structured team-based strategies and organisational support play a pivotal role in effectively managing and preventing violence. It suggests that interventions to reduce violence in psychiatric settings may benefit from a dual approach that addresses both individual psychological factors and systemic, team-based and organisational strategies.

Furthermore, our experience highlighted the importance of continuous training, situational drills and the development of a common language for team communication in crisis situations. These elements were instrumental in fostering a cohesive and responsive team environment, which, as suggested by the findings of Lambe et al, could be essential in managing violence precipitated by psychosis.

In conclusion, although we commend Lambe et al for their valuable contribution to understanding the psychological framework of violence in forensic patients with psychosis, we advocate for a broader perspective that also encompasses systemic, organisational and team-based strategies. Integrating such multidimensional approaches could enhance our ability to manage and prevent violence in psychiatric settings, ultimately ensuring the safety and well-being of both patients and healthcare professionals.