Earlier this year, the Joint Commission issued Sentinel Event Alert 59, on physical and verbal violence against healthcare workers. The alert includes OSHA’s statistic that workers in healthcare are four times more likely to be victimized than workers in private industry. Focusing on psychiatrists, consider these annual rates of non-fatal, job-related violent crime:

·        12.6 per 1,000 workers for all occupations

·        16.2 per 1,000 for physicians

·        68.2 per 1,000 for psychiatrists and mental health professionals

Violence in healthcare is vastly underreported – victims don’t want to “harm” the patient by reporting, victims believe it is just part of the job, and/or the psychiatric patient’s violence is unintentional, so unavoidable. Psychiatric residents are particularly vulnerable, while at the same time very reluctant to report patient violence. Forty to fifty percent of psychiatric residents will reportedly be physically attacked by a patient during their four-year training program. Such violence can be traumatic, and even cause some psychiatry trainees to leave the specialty.

Stalking by patients is a concern, particularly for psychiatrists. Authors Pathe and Meloydivide stalking behavior into brief intense periods and those lasting beyond two weeks. The longer term stalking is typically more dangerous to the psychiatrist. They also note the predominant motives are anger/resentment and infatuation.  Kaplan has compiled safety advice in this article.

Psychiatrists are reportedly killed more often by patients than physicians in other specialties. Knable has studied homicides of mental health workers by patients from 1981-2014, and found the following:

·        Ten of the 33 victims were psychiatrists.

·        Schizophrenia was the most common diagnosis.

·        Hospitals and private offices tied for most frequent location, and gunshot was the method in 70% of the cases (beating was the other 30%). 

·        Perpetrators also often had a history of violence, criminal charges, involuntary hospitalization, and non-adherence to medications. 

The article also includes safety advice. My additional advice is to remember that your safety and the safety of your staff are exceptions to patient confidentiality.

I think Anderson and West summed it up best by saying “the challenge for medical practitioners is to remain aware that some of their psychiatric patients do, in fact, pose a small risk of violence, while not losing sight of the larger prospective – that most people who are violent are not mentally ill and most people who are mentally ill are not violent.”

Stay safe out there…