New LHSC policy to assess risk of violence, aggression in all patients

People arriving at the London Health Sciences Centre will be screened for past violent or aggressive behaviour — in and out of hospital — and will be flagged to alert nurses, doctors and staff about the risk, CBC News has learned.

Doctors in the inpatient and outpatient mental health department say the move stigmatizes their patients

Victoria Hospital psychiatrists have started wearing these "Stop The Stigma" bracelets to protest a new screening tool that assesses patient risk based on past violent or aggressive behaviour. (Supplied)

London Health Sciences Centre patients will be screened for past violent or aggressive behaviour — in or out of hospital — and will be flagged to alert nurses, doctors and staff about the risk they pose, CBC News has learned. 

The new screening tool will be in place no later than May 1, according to paperwork obtained by CBC News. 

But psychiatrists who work with mental health patients at Victoria Hospital say the new practice unfairly singles out their patients, and have begun wearing "Stop The Stigma" bracelets as a silent but visual protest of the move. 

"The previous (violence-screening) policy was not always applied throughout the hospital," said James Murray, president of the Ontario Nurses Association Local 100, which represents 3,600 registered nurses at LHSC. 

The new screening tool will be used throughout the LHSC, at the Victoria and University hospital campuses, but particular attention is to be paid to make sure mental health outpatients are screened the same way that mental health inpatients are. 

Patients will be screened using the Acute Care Violence Assessment Tool, developed by the Public Services Health and Safety Association.

The tool gives points for any history of violence and points for behaviour observed in a patient, such as appearing confused, irritable, boisterous, agitated, paranoid, intoxicated or withdrawing from substances, screaming or being verbally or physically threatening. 

For each additional "observed behaviour," the tool increases the risk indicator. Anyone exhibiting one to three of those behaviours is flagged as a moderate risk; anyone with a score of four or five is a high risk, and those with six or more are a very high risk. 

Those who work with patients living with mental illnesses say they are much more likely to be the victims of violence than perpetrators of it. 

Attack on nurse led to policy change

Doctors on the mental health unit of Victoria Hospital are wearing these bracelets to protest changes to how patients are screened for risk of violence or aggressive behaviour. (Dave Chidley/CBC)

The new screening policy is a result of an incident that happened on April 16, 2017 when a male patient with a history of violence was admitted into the adult mental health unit at Victoria Hospital and assaulted a registered nurse. 

CBC News has obtained a copy of the Ministry of Labour memorandum of settlement that orders the hospital to use a "violence assessment tool" to screen patients for aggressive and violent behaviours both inside and outside of the hospital. 

As of May 1, patient electronic charts will include an electronic flag about a patients' risk level.

But there will also be visible non-electronic flags so all employees, such as porters and housekeepers who don't have access to the electronic files, can easily identify potentially violent or aggressive patients. Those include a visual marker on the patient's wristband, by the patient's bed, on the patient's door and on the paper chart. 

The Labour Board settlement describes the violence flag as similar to an allergy-alert flag. 

A LHSC spokesperson wouldn't speak about the new policy, saying only that there is "work underway to update the current policy" that has been in place since 2009.

In-class training about the new violence assessment tool is to be provided first for "high-risk units." Specifically, the acute mental health units, the psychiatric intensive care unit, the mental health outpatient clinic, the overflow room used to house mental health patients who don't otherwise have a bed, known as The Annex, the ER, and the geriatric behavioural unit. 

The 2017 incident and subsequent agreement also led to:

  • A third-party risk assessment of security measures on the adult mental health inpatient unit
  • A security guard with authority to detain a patient being at the mental health reception area from 7 a.m. until 11 p.m. 
  • A mandatory search policy for patients and visitors to the mental health unit. 

The LHSC is currently surveying staff, patients and family members about the "patient experience" in the mental health unit, a spokesperson said. 


Kate Dubinski


Kate Dubinski is a radio and digital reporter with CBC News in London, Ont. You can email her at