Sonia Sangha is a foundation year
I recently attended Psychiatry as a
career: Everything you wanted to know but were afraid to ask
at the Royal Society of Medicine.
Some of the lectures not only allayed concerns
and myths about psychiatry, but challenged some of my own
pre-conceived ideas. In particular, the section, Is psychiatry
a risky profession? presented by Dr Mark Salter and Dr
Victoria Cohen, was undeniably controversial, with 70% of the
audience agreeing that it was.
Dr Salter compared two studies to debate the
question he had set out for discussion.
The first (Wyatt and Watt) looked at 100
junior doctors working in Accident and Emergency departments in the
U.K. The study found that 18% of doctors, not including duty
on-call psychiatrists assessing patients in A&E, had been
assaulted by patients on a total of 23 occasions and that 32% had
said that patients had tried to assault them. None of those
assaulted received any counselling. Only 11% had received any
training on how to manage aggressive patients, although 88% had
believed that it would be useful.
The second study (S. Davies) set out to
determine the annual rates of assaults and threats to
psychiatrists. Over a year, 17% reported
one or more assaults and 32% reported one or more threats (see
table 1). In this case, 48% had
attended a course on dealing with aggressive patients, which 87%
had found useful.
Table 1. Frequency of assaults and threats
reported by respondents (n=139)
Number of incidents
Number of respondents (%)
Davies S. (2001) Assaults and Threats on
Psychiatrists. The Psychiatrist, 25, 89-91
Dr Salter concluded that the evidence from
these studies illustrated that violence in the mental health
population is no greater than that in the general population and
the cause of it is likely to be related to the same factors in the
two populations. Thus, psychiatry is no more ‘risky’ a profession
than other specialities.
Further research presented, showed that
substance misuse and psychopathy are often useful predictors of
violence in the mentally ill. Often substance abuse and mental
illness co-exist. These useful predictors, along with supervision,
greater opportunity to attend appropriate courses and supportive
colleagues, place psychiatrists in a ‘safer’ position.
In conclusion, mental illness and
violence are often considered intrinsically linked by doctors and
lay people alike, often due to skewed media coverage. For example,
the misunderstanding of schizophrenia as an illness, demonstrated
in Alfred Hitchcock’s film Psycho and schizophrenic
patients being portrayed as violent.
This is being addressed currently by the
campaign, Time to Change, after a YouGov poll of 2,010
people found that more than a third held the belief that all
sufferers of schizophrenia are violent!
Overall, the meeting was a great success and
it fulfilled my expectations. I left feeling that psychiatry is a
speciality that has a great deal of uncertainty and complexity
about it, but then that is what makes it unique and is the very
reason why I am committed to pursuing psychiatry as a