Violence in the acute hospital sector is a common occurrence; however, it is often poorly understood and managed when compared to violence in other healthcare or institutional settings. Aetiological factors, the victim profile and perpetrator profiles vary when compared to other settings. There are particular challenges when considering risk assessment and how violence is managed in these settings. We explore these challenges in the context of staffing, training, environmental factors and the medical model of care. The milieu of an emergency department with high-turnover acute healthcare delivery and the impact this has on violence and its management are also explored. We aim to describe the extent of the problem and provide recommendations specific to the challenges faced in the acute hospital setting, with learning being applied from outside sectors. The topical subject of acute behavioural disturbance/excited delirium is also discussed.

This series of brief reports highlights the experience of a London psychiatric intensive care unit (PICU) that cared for patients with COVID-19 relatively early in the pandemic. The objective is to contribute to learning and consider the challenges for psychiatric intensive care services. This article will discuss COVID-19-related risk prevention and mitigation strategies in a psychiatric inpatient setting, followed by an overview of the legal and ethical challenges, relating to risk prevention, mitigation and restrictive practice, in psychiatric inpatient care during the time of the pandemic.

The emergence of a drive to reduce restrictive interventions has been accompanied particularly in the UK by a debate focussing on restraint positions. Any restraint intervention delivered poorly can potentially lead to serious negative outcomes. More research is required to reliably state the risk attached to a particular position in a particular clinical circumstance.Declaration of interestF.S. is a consultant psychiatrist in Psychiatric Intensive Care at the Maudsley Hospital, London. He is on the Executive Committee of the National Association of Psychiatric Intensive Care and Low Secure Units, and was a member of the National Institute for Health and Care Excellence Guideline Development Group for the Short-Term Management of Aggression and Violence (2015). J.P. is a senior lecturer at the Faculty of Health and Life Sciences, Coventry University. E.B. is a consultant and expert witness in violence reduction and the use of physical interventions, independent expert to the High Secure Hospitals Violence Reduction Manual Steering Group and a member of the College of Policing Guideline Committee Steering Group and Mental Health Restraint Expert Reference Group. B.P. is the clinical director for Crisis and Aggression Limitation and Management (CALM) Training and formerly a senior lecturer for the Faculty of Health, University of Stirling. He is a nurse and psychotherapist and presently chairs the European Network for Training in the Management of Aggression. A.O'B. is a consultant psychiatrist, the Director of Educational Programmes for the National Association of Psychiatric Intensive Care and Low Secure Units, and the Dean for Students at St George's University of London.