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Violence against psychiatrists by patients: survey in a London mental health trust

  • Saleh Dhumad (a1), Anusha Wijeratne (a2) and Ian Treasaden (a3)
Abstract
Aims and Method

A survey was undertaken to investigate assaults of psychiatrists by patients in a 12-month period. Surveys were sent to 199 psychiatrists representing all sub-specialties and grades in a London mental health trust.

Results

There were 129 returned responses (response rate 64.8%). In the 12-month study period, 12.4% of all psychiatrists and 32.4% of senior house officers were assaulted. None received or took up offers of formal, as opposed to informal, psychological support. Most assaults occurred on a psychiatric ward. Vulnerability to assaults was not influenced by courses on prevention and management of violence or by the attitudes of psychiatrists to violence by psychiatric patients.

Clinical Implications

Senior house officers are most vulnerable to assaults. Greater attention may need to be given to psychiatric wards where most assaults occurred. Trusts should ensure that those assaulted are identified and offered support.

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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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Black, K. J., Compton, W. M., Wetzel, M., et al (1994) Assaults by patients on psychiatric residents at three training sites. Hospital and Community Psychiatry, 45, 706710.
Chaimowitz, G. A. & Moscovitch, A. M. (1991) Patient assaults against psychiatric residents: the Canadian experience. Canadian Journal of Psychiatry, 36 107111.
Davies, S. (2001) Assaults and threats on psychiatrists. Psychiatric Bulletin, 25, 8991.
Department of Health (1999) Campaign to Stop Violence Against Staff working in the NHS: NHS Zero Tolerance Zone (HSC 1999/226). Department of Health.
National Audit Office (2003) A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression. National Audit Office.
Pieters, G., Speybrouck, E., De Gucht, V., et al (2005) Assaults by patients on psychiatric trainees: frequency and training issues. Psychiatric Bulletin, 29, 168170.
Royal College of Psychiatrists (2006) Safety for Psychiatrists (Council Report CR134). Royal College of Psychiatrists.
Schwartz, T. L. & Park, T. L. (1999) Assaults by patients on psychiatric residents: a survey and training recommendations. Psychiatric Services, 50, 381383.
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BJPsych Bulletin
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  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Violence against psychiatrists by patients: survey in a London mental health trust

  • Saleh Dhumad (a1), Anusha Wijeratne (a2) and Ian Treasaden (a3)
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eLetters

"Safety at Workplace : A Trainees Perspective"

Aadil Jan Shah, MRCPsych, Speciality Registrar,
16 November 2007

There have been a number of studies published recently in Psychiatric Bulletin addressing the safety at workplace in psychiatry. Issues of safety continue to be a matter of concern, especially for trainees becauseof the recent major reforms in the postgraduate medical training in the UK (Wadoo et al, 2007).The study done by Saleh Dhumad et al (2007) shows that about 12% of the doctors were assaulted in a period of 1 year. Of the 19 assaults,11 were on SHO`s (57.9%) and most of the incidents (12 out of 19;63.2%) occurred on the inpatient units (psychiatric wards) (Dhumad et al, 2007).This suggests that SHO`s (trainees) are more vulnerable to assaults than the senior staff (consultants etc.) and it also suggests that the risks of an assault are greater in inpatient settings, especially on the acute adult psychiatry wards.Possible Reasons for the greater frequency of assaults on SHO`s (Trainees) are that :•Trainees are involved in dealing with the routine patient problems on the ward, do the regular MSE, physical examination and risk assessments.•Trainees being first on call attend for most of the urgent or emergency situations.•Trainees at the start are inexperienced and at times find it difficult to manage the volatile situations.•Trainees because of their inexperience sometimes don’t take all the necessary safety precautions resulting in an assault.•Changes in their placements after every 6 months (new surroundings, new patients, probably a new safety policy).•Changes from one subspeciality to another (e.g; from child psychiatry where one does not necessarily take all the safety precautions to an acuteadult setting where things are more volatile).•Lack of proper safety features on the wards and assessment rooms that arerecommended by the Royal college. •There might also be patient-related factors pertaining in acute psychiatric wards that include; being a young male with a diagnosis of schizophrenia (Calcedo-Barba et al, 1994), particularly with neurological impairment (Krakowski et al, 1994) ; havinga history of violence (Morrison, 1992) ; and being involuntarily admitted to the hospital (James et al ,1990); having substance abuse (Palmstierna et al,1989), personality disorder and bipolar disorder (Miller et al,1993)have also been shown to be related to violence.

Whose responsibility is it if a trainee is assaulted?

It is the responsibility of both trusts (employers) and trainees (employees) to establish and maintain all the safety precautions to prevent these hazards. As per the Health and Safety Work Act 1974 "A hospital or other NHS body is criminally liable, if it fails to ensure, so far as is reasonably practicable, the safety at work of its employees" and all the employees have a duty under the Act to take reasonable care of their health and safety and the health and safety of their colleagues. Employees too must co-operate with their employers infulfilling their statutory obligations" (Health and Safety Work Act, 1974).

How to improve safety for trainees?

The Collegiate Trainees Committee has repeatedly addressed issues around trainees safety and has issued a number of clear recommendations regarding safety training, induction courses, local policies and procedures, and safety standards for interview rooms (Cormac et al, 1999).If these recommendations are followed strictly, the episodes of assaults on trainees will reduce.

In my personal experience I have found a number of safety recommendations lacking at different placements throughout my training. I was also involved in an safety audit which clearly showed lackof some important safety factors in the wards and the assessment rooms. Recommendations for improvement were provided and regular re-auditing was advised. To bring about these improvements it was found that several aspects of the organization needed to be changed which entailed greater financial expenditure. Considering the present financial problems throughout the NHSorganizations this is likely to be difficult. Therefore, as a trainee, I would recommend ensuring that all the basic safety precautions are taken. All violent incidents against trainees should be reported by filling an incident form. As recommended by Royal College a trainee should contact their educational supervisor, College tutor or the consultant on-call to discuss the incident. Debriefing, leave of absence where appropriate and other psychological support are recommended following a violent incident (Cormac et al, 1999). Trainees should conduct regular audits on safety throughout their placements.

References:

Calcedo-Barba AL., Calcedo-Ordonez A. (1994) Violence and paranoid schizophrenia. International Journal of Law and Psychiatry 17, 253-263.

Cormac, I., Crean, J., Motreja, S. (1999) Report of the CTC Working Party on the Safety ofTrainees. London: Royal College of Psychiatrists.

Dhumad S., Wijeratne A., Treasaden I. (2007) Violence against psychiatrists by patients : survey in a London mental health trust. Psychiatric Bulletin 31,371 – 374.

Health and Safety at Work etc Act (1974).

James DV., Fineberg NA., Shah AK., et al. (1990) An increase in violence on an acute psychiatric ward: a study of associated factors. British Journal of Psychiatry 156,846-852.

Krakowski MI., Czobor P.(1994) Clinical symptoms, neurological impairment, and prediction of violence in psychiatric inpatients. Hospitaland Community Psychiatry 45,700-705.

Miller RJ., Zadolinnyj K., Hafner RJ.(1993) Profiles and predictors of assaultiveness for different psychiatric ward populations. American Journal of Psychiatry 150,1368-1373.

Morrison EF. (1992) A coercive interactive style as an antecedent to aggression and violence in psychiatric inpatients. Research in Nursing andHealth 15,421-431.

Wadoo O., Shah AJ., Ahmed ZZ. (2007) Safety at WorkPlace, e-letter, Psychiatric Bulletin.

Palmstierna T., Wistedt B. (1989) Risk factors for aggressive behaviour are of limited value in predicting the violent behaviour of acute involuntary admitted patients. Acta Psychiatrica Scandinavica 81,152-155.
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Conflict of interest: None Declared

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