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Safety of Mental Heath Workers in Developing Countries
- Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Dr. Aruni Hapangama MD, Lecturer in Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka (11 May 2008)
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Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, Dr. Aruni Hapangama MD, Lecturer in Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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lalithkuruppu{at}lycos.com Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), et al.
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The article by Dibben C et al (2008) was read with much interest as safety considerations for mental health staff continue to be an issue of serious concern globally. Unfortunately, there have been very few reports addressing the safety needs of psychiatrists, particularly in developing countries like Sri Lanka. Assault on psychiatrists is an important occupational hazard and there is some evidence that violence in psychiatric wards may be underreported (Owen et al, 1998). Many believe that violence in the form of verbal abuse is “part of the job” and some even regard physical abuse as a part of being a psychiatrist or a mental health care worker and may not volunteer to report such incidents. This may be because such incidents are hardly ever properly investigated, workers compensation policies that do not adequately address the issue, etc. Another important consideration in the future may be the “emotional abuse” of the mental health workers. A study done in Sri Lanka with regard to violent incidents towards the Psychiatric trainees demonstrated that 60% of them were verbally abused while 27% had experienced physical violence (More details available from the first author upon request). Most in-patient psychiatry units in our part of the world are overcrowded. There is lack of structured activity, low levels of staff–patient interaction, poor staffing levels, unpredictable ward programmes and a lack of privacy in these units. Some of these factors have found to be among the environmental risk factors that increase the risk of violence among the mentally ill patients (Royal College of Psychiatrists 2006). The lack of suitable interview rooms, flaws in the design of in-patient units, inadequate high dependency and seclusion facilities and the lack of personal alarms or chaperones can worsen the risk to the staff working in these units. Another factor which leads to the escalation of violence in acute in- patient units, especially in our part of the world may be the overcrowding of these units with a variety of patients such as adults with psychosis, substance misuse, “forensic problems” as well as patients with dementia. Junior psychiatrists and nurses in most units have not had sufficient training in the recognition and prevention of violence and in using de- escalation strategies. The need for adequate and regular training to the staff working at psychiatry units with regard to prevention and management of violence should be emphasized and protocols, guidelines and effective reporting systems must be developed in relation to the above. While appreciating the physical resources it is important to incorporate conflict resolution skills in the training programs in mental health care workers in order to facilitate the negotiation skills. Aggression and violence towards the staff working at psychiatry units can often be prevented; obviously this relies heavily on the awareness and skills of the medical and other staff of these units. Reference Dibben C, O’Shea R, Chang R, Woodger J. Safety for psychiatrists - from trainee to consultant. Psychiatric Bulletin. 2008; 32: 85 – 87 Owen C, Tarantello C, Jones M. et al. Violence and Aggression in Psychiatric Units. Psychiatric Services.1998; 49:1452–1457. Royal College of Psychiatrists. Safety for Psychiatrists (CR134). 2006. Royal College of Psychiatrists. |
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