Since St. Brendan's is a psychiatric hospital, aggressive behaviour is always in the nurses' minds because it can occur at any time, and without warning.

The Somers Annex intensive care unit, where acutely disturbed patients are admitted, is the area of highest volatility, because patients arriving there present the greatest risk to the nursing staff.

Therefore, in addition to regular security measures, the nurses are specially trained to deal with aggression through proper defensive techniques. The system is known as Protective Intervention Training (PIT) -- a programme which includes both theoretical and practical aspects.

In order to keep their PIT accreditation, nurses must take regular refresher courses, and St. Brendan's is currently addressing the shortage of qualified trainers so that PIT can be offered, not only to all of its staff members, but also to King Edward's Emergency Department personnel, and the Police and Fire Service, as it once was.

In terms of dealing with someone who exhibits bizarre behaviour in the community, St. Brendan's has several options: 1. It can let the Police deal with the situation independently and convey the person to a place of safety.

2. If the person is known to St. Brendan's, the hospital can ask the Police to assist its staff in dealing with them.

3. It can call in St. Brendan's 24-hour Crisis Intervention Team, consisting of a psychiatrist and mental welfare officer, to assess the seriousness and level of risk involved, and determine whether Police intervention is required from a public safety perspective.

"Based on the level of violent behaviour, once a person arrives at St.

Brendan's it is more than likely that he or she will be nursed in the Somers Annex intensive care unit,'' mental health services programme manager Glenn Caisey says. "Then we have to manage the individual until we arrive at the goal of symptom control and safety, where he or she is not at risk to themselves and others.'' Noting that Somers Annex has only five beds, Mr. Caisey says this is because Bermuda is a small community and St. Brendan's is therefore able to offer better after care follow-up to its clients.

"There is a good collaboration and follow-up, so we can be pro-active and recognise changes before they become explosive,'' he says. "In fact, we continually promote education to the public about using mental health services at an early rather than a late stage.'' Stating that "mental illness is co-occurring with a physical illness, and you can't have one without the other'', the mental health services programme manager agrees that a lot of hospital and community nurses are being exposed to violence these days.

"More so now in our society we are getting the catalytic factor of substance abuse which increases the potential for violent behaviour, and in nursing we are as exposed as the next person to that, so we have to be trained and alert to deal safely with the behaviour,'' he said. "The style and the way in which we expedite our response is critical in reducing the volatility of a situation. Nurses must have good communication skills.''