Mental health professionals in Boston say violence rare among psychiatric patients

From The Boston Globe:

Assaults on therapists, such as the stabbing of a doctor by a psychiatric patient in a Massachusetts General Hospital clinic yesterday, capture widespread attention, but several mental health professionals said such events are rare. Still, they said, doctors can take precautions when treating psychiatric patients.

A study published earlier this year in the journal Archives of General Psychiatry found that mental illness by itself did not make a person more prone to violence. Only when it is combined with other factors, such as substance abuse or a history of violence or stressful situations such as losing a job or divorce, did mental illness predict future violence in the study of more than 34,000 people.

“This is not an ever-present issue,’’ said Dr. Joseph Glenmullen, a private practice psychiatrist who supervises doctors in training at Cambridge Health Alliance and worked at Harvard University Health Services for 20 years. “It’s very rare. I’ve never felt unsafe.’’

Glenmullen said that he had an alarm button under his desk at Harvard services but never used it. He also pointed out that doctors can take precautions when there is the possibility of violence from a patient. During his first year of training, he treated a patient at a state hospital who had lunged at the face of a previous therapist. He said he met with the patient in a large common room as a precaution.

Yesterday’s incident, in a building Mass. General leases for its Bipolar Clinic and Research Program, follows several other high-profile cases of violence that shook the mental health community, including the killing of a New York City therapist and an attack on a psychiatrist last year, allegedly by a man who blamed the psychiatrist for having him institutionalized nearly two decades earlier. In 2006, Wayne Fenton, associate director of the National Institute of Mental Health, was beaten to death by a schizophrenic patient.

Several psychiatrists who worked in emergency room settings said that violence was a real risk. According to the National Crime Victimization Survey, the annual rate of nonfatal violence in the workplace was higher for mental health workers than for other medical professionals between 1993 and 1999. Physicians experienced 16.2 violent victimizations per 1,000 workers, and nurses experienced 21.9 per 1,000 workers, while mental health professionals experienced 68.2 such victimizations per 1,000 workers.

“Much more needs to be done in psychiatric training to prepare people,’’ said Dr. Carl Bell, director of the Institute for Juvenile Research at the University of Illinois at Chicago. “Part of the difficulty that psychiatrists have when they’re attacked by patients is that they’re a healer. . . . They’re very conflicted about these conversations, because on the one hand it’s ‘do no harm,’ but on the other hand it’s ‘wait a minute, I have a right to defend myself against violence.’ ’’

Dr. Julie Holland, who spent nine years working weekends in the psychiatric emergency room at Bellevue Hospital Center in New York City, said that in her time there she was punched in the face once by a patient. While violence is a risk when dealing with mentally ill patients, she added, a much better predictor of violence was someone who was intoxicated.

“I do think there’s sort of a lot of public misperception about how dangerous psychiatric patients are,’’ said Holland, who recently chronicled her experience in a book, “Weekends at Bellevue.’’

Marc Kullman, cofounder of the National Bipolar Foundation, worried that the attack would reinforce stereotypes about people with mental illness.

“It’s a vicious cycle, because the more stigma is created from an incident like this, the less people that need help will come forward to get help,’’ Kullman said. “People need to see this is an isolated incident, but also take this opportunity to discuss bipolar openly and begin to seek help for people that are affected.’’