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Safety for psychiatrists – from trainee to consultant

  • Claire Dibben (a1), Rory O'Shea (a2), Ricci Chang (a3) and Joanna Woodger (a3)
Abstract
Aims and Methods

To assess safe practice in psychiatry and self-perceptions of safety among trainees (Senior House Officers (SHOs) and Specialist Registrars (SpRs)) and consultants, a questionnaire was sent out to all general adult and old age psychiatrists, including trainees, in a teaching hospital and a district general hospital in East Anglia.

Results

A total of 29 SHOs, 11 SpRs and 27 consultants were approached (response rate 92%). In the past year 69% SHOs, 45% SpRs and 11% consultants attended breakaway training. Interview rooms were frequently below the Royal College of Psychiatrists' standards; 87% of the rooms did not have a panic button and 62% were isolated. Most doctors had felt threatened over the past 6 months but only 31% carried a personal alarm. Despite similar frequencies of assaults, consultants felt safer at work than trainees.

Clinical Implications

Safety is important for doctors throughout their careers and should be regularly reviewed by individuals as well as audited by hospital trusts.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Department of Health (1999) Campaign to Stop Violence Against Staff Working in the NHS. Department of Health.
Royal College of Psychiatrists (1999) Safety for Trainees in Psychiatry (CR78). Royal College of Psychiatrists.
Royal College of Psychiatrists (2004) Psychiatric Services to Accident and Emergency Departments (CR118). Royal College of Psychiatrists.
Royal College of Psychiatrists (2006) Safety for Psychiatrists (CR134). Royal College of Psychiatrists.
Royal College of Psychiatrists (2007) National Audit of Violence – Standards for Adult In-Patient Mental Health Services. Royal College of Psychiatrists.
Sipos, A., Balmer, R. & Tattan, T. (2003) Better safe than sorry: a survey of safety awareness and safety provisions in the workplace amoung specialist registrars in the South West. Psychiatric Bulletin, 27, 354357.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Safety for psychiatrists – from trainee to consultant

  • Claire Dibben (a1), Rory O'Shea (a2), Ricci Chang (a3) and Joanna Woodger (a3)
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eLetters

Safety of Mental Heath Workers in Developing Countries

Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry
11 May 2008

The article by Dibben C et al (2008) was read with much interest as safety considerations for mental health staff continue to be an issue of serious concern globally. Unfortunately, there have been very few reports addressing the safety needs of psychiatrists, particularly in developing countries like Sri Lanka.Assault on psychiatrists is an important occupational hazard and there is some evidence that violence in psychiatric wards may be underreported (Owen et al, 1998). Many believe that violence in the form of verbal abuse is “part of the job” and some even regard physical abuse as a part of being a psychiatristor a mental health care worker and may not volunteer to report such incidents. This may be because such incidents are hardly ever properly investigated, workers compensation policies that do not adequately addressthe issue, etc. Another important consideration in the future may be the “emotional abuse” of the mental health workers.A study done in Sri Lanka with regard to violent incidents towards the Psychiatric trainees demonstrated that 60% of them were verbally abused while 27% had experienced physical violence (More details available from the first author upon request).Most in-patient psychiatry units in our part of the world are overcrowded.There is lack of structured activity, low levels of staff–patient interaction, poor staffing levels, unpredictable ward programmes and a lack of privacy in these units. Some of these factors have found to be among the environmental risk factors that increase the risk of violence among the mentally ill patients (Royal College of Psychiatrists 2006). Thelack of suitable interview rooms, flaws in the design of in-patient units,inadequate high dependency and seclusion facilities and the lack of personal alarms or chaperones can worsen the risk to the staff working in these units. Another factor which leads to the escalation of violence in acute in- patient units, especially in our part of the world may be the overcrowding of these units with a variety of patients such as adults withpsychosis, substance misuse, “forensic problems” as well as patients with dementia.Junior psychiatrists and nurses in most units have not had sufficient training in the recognition and prevention of violence and in using de-escalation strategies. The need for adequate and regular training to the staff working at psychiatry units with regard to prevention and managementof violence should be emphasized and protocols, guidelines and effective reporting systems must be developed in relation to the above. While appreciating the physical resources it is important to incorporate conflict resolution skills in the training programs in mental health care workers in order to facilitate the negotiation skills.Aggression and violence towards the staff working at psychiatry units can often be prevented; obviously this relies heavily on the awareness and skills of the medical and other staff of these units.

ReferenceDibben C, O’Shea R, Chang R, Woodger J. Safety for psychiatrists - from trainee to consultant. Psychiatric Bulletin. 2008; 32: 85 – 87Owen C, Tarantello C, Jones M. et al. Violence and Aggression in Psychiatric Units. Psychiatric Services.1998; 49:1452–1457. Royal College of Psychiatrists. Safety for Psychiatrists (CR134). 2006. Royal College of Psychiatrists.
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