Are psychiatrists subject to more violence than doctors in other specialities?

Sonia Sangha is a foundation year two doctor.

Risky business

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. 

Two studies

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.

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.

Not deterred

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 career.