Psychiatric hospitals can be challenging environments in regards to staff safety. Psychiatric patients are generally suffering from severe, acute mental health conditions when they are admitted to a ward. As a result, they are often more prone to violent outbursts and unpredictable behavior than patients in other departments.
One study published in 2016, showed that 69.5% of staff at a large psychiatric hospital had experienced a physical assault in the previous 12 months. This high level of violence can have a huge impact on the nurses, doctors and support staff that work in both outpatient and inpatient psychiatric units. Endemic workplace violence can drive staff turnover, reduce morale and have a knock-on effect on the quality of patient care.
Taking steps to address workplace violence will not only help to improve the quality of treatment patients receive, it can also boost staffing levels and ensure medical professionals feel safe and secure when caring for their patients.
Why Is Staff Safety in Mental Health Facilities Important?
Staff safety is important in all healthcare settings. No healthcare workers or other members of the hospital staff should feel threatened or at risk in the workplace and all health facilities should work to mitigate common risk factors and create safe, secure working environments.
Safety is a particularly important issue in mental health care facilities because patients suffering from mental illness are statistically more likely to show aggressive behavior than those on general hospital wards. A 2015 study showed that around 1 in 5 (17%) of psychiatric inpatients had committed at least one act of violence during their stay in hospital. Studies that contain higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol and substance use disorders reported even higher rates of aggressive behavior.
Exposure to frequent patient attacks and violent behavior can have a serious impact on the mental and physical well-being of staff members. Working in a dangerous environment can result in health care workers experiencing depression, anxiety and anger, as well as physical injuries.
What’s more, endemic violence in mental health units can place a significant strain on working relationships. This often-overlooked side-effect of workplace violence can make it more likely for healthcare professionals to experience bullying, stress and inter-staff conflict, all factors that can affect patient care and staff morale.
Putting measures in place to improve staff and patient safety on psychiatric wards is an important step in violence prevention and risk management. With more support and better training, psychiatric nurses and doctors can create a safer working environment, protecting themselves, and their patients, in the process.
The Impact of Conflict and Assault on Psychiatric Nurses
Dealing with violent, high risk patients day in, day out can take a real toll on the mental and physical wellbeing of nursing staff working in psychiatric services. Though each nurse's experience will be unique, most will face similar challenges and feel the effects of frequent violence and threatening behavior in their professional and personal lives.
Some of the most common results of frequent exposure to violence in the workplace include:
Psychological and Emotional Consequences
The psychological and emotional consequences of experiencing violence in the workplace can be severe and long lasting. According to studies carried out in Japan and Israel, registered nurses working in mental health services suffer higher rates of burnout and post-traumatic stress disorder (PTSD) compared to nurses working in other specialties.
Many also experienced secondary traumatic stress (STS). STS is a syndrome whose symptoms include intrusion, avoidance and arousal resulting from indirect traumatic exposure in a professional context. It can happen when violence occurs regularly in the workplace, creating an unsafe environment and making staff concerned for their own personal safety.
STS is common in psychiatric hospitals because nurses working in mental health care not only suffer violence themselves, but also hear stories of their colleague’s experiences with violent patients. This indirect trauma can have a deep and long-lasting effect on the mental health of psychiatry nurses.
As well as taking a toll on mental health, exposure to frequent violence in the workplace can have a detrimental impact on physical wellbeing. Most obviously, experiencing a physical assault can result in serious injury. According to the CDC, 70% of those who experienced non-fatal trauma in the workplace in 2019 worked in the healthcare and social assistance industries.
These injuries can cause long term disabilities and require ongoing treatment. Even minor injuries can result in days off work, loss of earnings and loss of productivity. Difficulty sleeping is another common consequence of workplace violence. A chronic lack of sleep can have a knock-on effect on physical health and wellbeing.
Research published in 2021 revealed that people exposed to frequent violence in the workplace are at a significantly increased risk of suffering from depression. This depression can occur up to two years after the violent incident itself. Depression can be mild or severe and can include symptoms such as:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities once enjoyed
- Difficulty thinking, concentrating or making decisions
- Feeling worthless or guilty
- Changes in appetite
- Weight loss or gain unrelated to dieting
- Trouble sleeping or sleeping too much
- Loss of energy
- Increased fatigue
- Increased purposeless physical activity (such as fidgeting or the inability to sit still)
- Thoughts of death or suicide
It’s not uncommon for medical professionals employed in mental health nursing to feel angry about the conditions they are expected to work in. If doctors and nurses don’t feel that their personal security is a priority – and that they, or their colleagues, are being put at risk because of a poor attitude to workplace safety – they are very likely to feel angry and resentful towards their health administration or managers. This can result in high staff turnover and a negative working environment. This anger is likely to grow every time an assault or violent incident takes place.
Tips to Ensure Workplace Safety in Psychiatric Hospitals
Reducing violence in psychiatric hospitals, outpatient units, acute care and emergency departments will help to create a safe environment for both patients and medical professionals. While some steps involve financial investment, many simply require time and a commitment to staff safety.
Here, we take a look at some of the most effective measures hospitals can put in place to keep both patients, and the staff who care for them, safe from harm.
Regulation and Monitoring
Regulation and monitoring can help to control who enters a psychiatric hospital. It can also allow medical professionals to keep an eye on those already on the premises. Video monitoring, increased levels of security personnel and electronic entry systems can all make it easier to manage the space and ensure only authorized patients and staff members are allowed to enter.
Conduct Trend Analysis of Critical Incidents
Analyzing the data around critical incidents is one of the most effective ways of improving safety in a psychiatric setting. Conducting trend analysis involves looking closely at past critical incidents to predict what can cause – and prevent – future assaults.
In order to carry out thorough trend analysis, psychiatry departments will need to have a systematic review of previous incidents. This should help to inform staff about which interventions and behaviors are effective in de-escalating a situation and which can lead to a worsening of patient violence and aggression.
Staff working in psychiatric inpatient care should be encouraged to report all incidents of verbal and physical aggression in as much detail as possible. This data can then be used to analyze and predict patient behavior and help keep staff safe.
Training and Education
Training and education are crucial when it comes to staff safety and reducing violence in mental health systems. Staff should be trained in de-escalation techniques and be taught how to spot warning signs in potentially violent patients.
Training could also include sessions on identifying and dealing with potential triggers for violent patients and those suffering from behavioral health issues.
Training and education should generally focus on preventative safety measures. However, learning basic self-defense techniques, and being trained on the safe and appropriate use of restraints, can help to keep patients and medical professionals safe from harm.
As well as learning how to prevent patient violence and deal safely with those suffering acute symptoms, psychiatry nurses should also learn how best to support each other. While most nurses will be aware of the symptoms of depression, PTSD and STS in patients, they should also be encouraged to look out for warning signs in their colleagues.
A clear plan should be put in place to allow staff to report any concerns they have about the mental or physical wellbeing of their colleagues. This should help to foster a more supportive environment, boost teamwork and mitigate some of the challenges of working with aggressive or unpredictable patients.
Use Technology to Ensure Staff Safety
Employing specially designed technology on a psychiatric ward can go a long way to improving staff safety and reducing violence. Technology can make it easier to monitor the people coming in and out of the premises and ensure staff can get help quickly if they feel threatened.
For example, issuing each member of staff on the ward with wireless panic buttons will make it a lot easier for colleagues and security personnel to assist a person in distress. Staff can use wireless panic buttons to call for help if a patient is displaying aggressive or violent behavior. They can also use them to summon assistance quickly in the case of patient self-harm or a medical emergency.
Carrying out a thorough risk assessment should help hospital managers and healthcare providers to identify the technology that best suits their requirements.
If you’d like to learn more about how technology, and wireless panic buttons in particular, can keep your doctors, nurses and support staff safe from harm, take a look around or get in touch with a member of our team.