This article is more than 5 years old. Information may no longer be current.

Top 11 ways to improve psychiatrist safety

A feature article recently published in Psychiatric Annals discussed the issue of homicides of mental health workers by patients and offered recommendations for improving practice safety for practitioners.

Findings from a systematic search for accounts of homicides of mental health workers between 1981 to 2014 indicated one homicide occurred per year.

The most common perpetrators were males diagnosed with schizophrenia. Guns accounted for 42.4% of homicides, while 57.6% were due to “less lethal, and possibly preventable, means,” according to Michael B. Knable, DO, executive director of the Sylvan C. Herman Foundation, Frederick, Maryland.

Knable recommended the following to improve safety of mental health workers:

1. Develop the ability to assess danger level during a prescreening interview prior to the patient’s first appointment;
2. Be mindful of evening or weekend appointments or those when additional office personnel are not present;
3. Have family members or colleagues accompany patients with a history of violence or poor impulse control;
4. Have a security barrier between the waiting room and consulting room, which may include electronic locks or video surveillance;
5. Sit behind a desk rather than a “traditional psychotherapeutic environment,”
6. Develop an escape route;
7. Have an emergency alert system, if feasible;
8. Conduct home visits to patients with a history of violence or involuntary treatment in teams;
9. Obtain consultation sooner rather than later for patients who become threatening. In isolated settings, conduct consultation with other colleagues, and in institutional settings, report threats immediately;
10. Inform law enforcement of direct threats that occur outside of the therapeutic setting; and
11. Evaluate the need for restraining orders and understand that they can provoke increased threats or violence.

“Homicides seem to have been committed against a wide range of professional roles within the mental health system,” Knable wrote. “The largest single group to have been victimized appeared to be young women case workers who had been sent, usually unaccompanied, to perform tasks within residential treatment settings. This would appear to be a practice that could be remedied quite easily with appropriate safety measures followed in these settings. Although residential facilities were a common site for the homicides we found, it is important to note that no particular clinical setting seemed to be immune from the risk for attack. It may be misguided for practitioners in private offices to feel safe without putting into place specific safeguards.” – by Amanda Oldt

Disclosure: Knable reports holding stock with MedAvante, Inc.