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The Royal College of Psychiatrists Improving the lives of people with mental illness

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

Sonia Sangha is a foundation year two doctor.

Risky business

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

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.

 

Table 1. Frequency of assaults and threats reported by respondents (n=139)

 

Incident

 

Number of incidents Number of respondents (%)
Assaults 0 115 (83%)
  1 14 (10%)
  2 8 (6%)
  3 1 (%)
  4 1 (%)
Threat 0 94 (68%)
  1 26 (19%)
  2 14 (10%)
  3 3 (2%)
  4 2 (1%)

 

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.

 

Not deterred

Sonia Sangha is a foundation year two doctorIn 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.

  

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Comments

Re: Are psychiatrists subject
NHS protect collects annual statistics for assaults on staff within the NHS, and the latest figures show clearly that mental health and learning disability sectors are by far the most violent sectors of the NHS. Over 70% of all physical assaults occur in MH&LD settings - thats over 43,000 assaults a year. The stats show that some around 35,000 of these assaults were directly related to the patient's illness. Around 1 in 5 MH&LD staff said they had been assaulted by a patient, the highest for any sector of the NHS.
These figures are not an isolated one off - they have been demonstrated year on year.
This is a serious problem that causes harm to patients, staff and the public alike and pretending it doesn't exist does nobody any favours.
You can find the official stats here: http://bit.ly/1gbN1Ey
And more scientific studies on mental illness and violence here:
http://bit.ly/1ltwkGF
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