Perpetrator characteristics

Ethnographic research teams conducted several hundred hours of interviews with a wide range of NHS staff, as well as patients and their friends and family, the police, mental health experts and A&E design experts.

They identified six sets of perpetrator characteristics, highlighting the diversity of individuals who become violent and aggressive in A&E. In creating these perpetrator profiles, the aim was not to stereotype or pigeonhole, or to presume the guilt of innocent people. Rather, it was intended to highlight distinct challenges and ‘aggression pathways’ that can be used to focus or test design ideas. It is also noteworthy that many of the perpetrators of violence and aggression exhibit two or more of the identified characteristics. These kinds of overlaps were deliberately ignored in the interests of clarity, but in practice make managing perpetrators and reducing acts of violence and aggression far more complex and difficult.

Clinically confused illustration

Clinically confused

Medical staff make a distinction between incidents with clear intent and those which, lacking intent, may have occurred as a direct result of the patient’s illness or medical condition, particularly where that condition results in impaired cognition

Frustrated illustration

Frustrated

For the majority of attenders to A&E, the goal is simple: to receive the attention they need, as quickly as possible. People can easily be frustrated by waiting

Intoxicated illustration

Intoxicated

Intoxication, in particular alcohol consumption, is believed by staff to be one of the most significant contributors to violence and aggression in A&E departments

Anti-social illustration

Anti-social/angry

The antisocial character is likely to have past experience of being violent or aggressive

Distressed illustration

Distressed / frightened

For some visitors and patients, being in A&E can be a highly emotional experience. These emotions can range from stress and anxiety, to shock, surprise or immense grief

Socially isolated illustration

Socially isolated

A&E can become a strange gathering place for all sorts of people who are lonely or have nowhere else to go

Triggers of violence and aggression

Beyond individual characteristics that may make an individual more or less likely to be violent or aggressive, there may be triggers that cause peple to react badly.

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