Marco De Tubino Scanavino: Preventing Violence in Psychiatric Settings
By: Houda Houbeish
Violence in psychiatric settings poses a significant challenge for patients, families, and healthcare providers. Preventing these incidents is not only critical for patient safety but also essential for creating safer, more supportive clinical environments.
Through his participation in the Health Data Research Network Canada (HDRN Canada) Pragmatic Trials Training Program, Dr. Marco De Tubino Scanavino, a psychiatrist and clinician-researcher at Western University, is developing a pragmatic trial to test an innovative intervention he designed to reduce violent behaviour among psychiatric inpatients.
From Research to Intervention
Dr. Scanavino’s interest in risk behaviour stems from prior research in Brazil on sexual compulsivity, paraphilic disorders, and associated risks for violence. “There is a link between compulsive sexual behaviour and risk for violence, and also between paraphilic disorders and violence,” he explains. He has also worked extensively with individuals with severe mental illness in day hospitals, exploring therapeutic strategies to support patients’ functioning and safety.
Drawing on previous research, Dr. Scanavino developed a proactive, patient-centred intervention inspired by safety planning used to prevent suicide, but adapted to manage aggression. Rather than relying solely on reactive measures, the approach involves collaboratively creating individualized safety plans with patients identified as at risk for aggression.
“What we don’t have in general is working with the patient to build a collaborative safety plan in order to prevent the escalation of aggressive behaviour,” he notes.
The intervention complements standard care by integrating evidence-based de-escalation techniques and environmental safety measures while actively engaging patients in shaping a safer ward environment.
“The idea of the intervention is inviting the patient to work collaboratively to have a safer environment while they are admitted to the ward,” Dr. Scanavino emphasizes. Nurses in psychiatric units are trained to implement these strategies, supporting patients in recognizing triggers and practicing strategies to manage emotions before aggressive incidents occur.
Testing the Approach: A Pragmatic Trial
To determine whether this intervention is effective in real-world settings, Dr. Scanavino is developing a pragmatic trial protocol as part of the HDRN Canada pragmatic trials training program. Unlike traditional clinical trials, which often exclude complex patients or set strict eligibility criteria, this trial is designed to reflect the realities of psychiatric wards. "Pragmatic trials let us see how treatments perform in real-world settings, not just under ideal conditions," he explains.
The trial begins with a feasibility study to evaluate whether the intervention can be successfully implemented in inpatient settings, including patients with severe mental illness who may have challenges with emotional regulation. When conducted, the study will assess practical considerations such as integrating the approach into routine care, training staff, and ensuring patient participation. Subsequent phases will examine outcomes such as reductions in violent incidents, improvements in ward safety, and patient engagement.
“This experience allows me to optimize resources, decrease costs, and get meaningful results while working closely with patients and staff,” Dr. Scanavino says. By testing his intervention pragmatically, he hopes to produce evidence that is directly applicable to everyday clinical practice, bridging the gap between research and patient care.
Dr. Scanavino’s work represents a shift from reactive to proactive care, aiming to prevent violence before it occurs and create psychiatric environments that are safer for everyone. As he puts it, “If we provide care, we can prevent violence.”
** The HDRN Canada pragmatic trials training program is coordinated and hosted by the Schulich School of Medicine & Dentistry and is an initiative by Health Data Research Network (HDRN) Canada. It has been funded with $3.48 million from the Canadian Institutes of Health Research (CIHR). Read more.
