In the days after Wichita psychiatrist Achutha Reddy was killed and one of his patients arrested, some mental health workers have had second thoughts about their careers, said Moneeshindra Mittal, medical director for behavioral health at Via Christi.
They’re quickly tempering that gut reaction with the knowledge that people with mental illness are no more dangerous than other people, Mittal said.
Yet mental health workers still face the possibility of violence from patients, something a 2008 article from the American Psychological Association called “rare, but a reality.”
Assaults accounted for 7 percent of workplace injuries to nursing, psychiatric and home health aides from 1995-2004, according to data collected by the Bureau of Labor Statistics. In contrast, only 1 percent of injuries among all occupations resulted from assaults. The rate of violence in the workplace is 69 times higher for psychiatric aides than others — and 38 times higher for psychiatric technicians.
This means that mental health providers face a balancing act: taking precautions while avoiding further stigmatization of mental illness.
“There’s a fine balance and I think we are all struggling with knowing where the fine balance is, especially when an incident like this happens,” Mittal said.
Every resident who goes through KU School of Medicine-Wichita’s department of psychiatry and behavioral sciences is trained on how to identify warning signs of aggression and de-escalate a situation, said Matthew Macaluso, director of residency.
If a patient shows warning signs such as wringing hands or increasing volume, employees may take the precaution of meeting in a public area, rather than a private office.
“Paying attention to the patient and surroundings is very important no matter what field of medicine you’re in,” Macaluso said.
Many facilities are locked, buzzing patients in.
At Via Christi’s inpatient programs, guests must leave their cell phones and purses outside the unit and items for patients are searched, said Kelli Chase, a social worker at Via Christi Behavioral Health.
“I think all of us who work in the mental health field have probably experienced some type of violence or aggression in some shape or form, whether physical or verbal,” Chase said.
Employees at Via Christi Behavioral Health Services also wear panic buttons on their badges in case they need to alert security.
In other places she has worked, facilities are less tightly secured in order to not look punitive, Chase said. Walking through metal detectors or a police presence can frighten people, meaning providers weigh whether those things are necessary.
The Robert J. Dole VA Medical Center also has an alarm system for staff. Another precaution is that a handful of patients, usually people who have had multiple violent episodes in the past, have police escort, said Melissa Harding, associate chief of staff of behavioral health.
The VA police also make rounds, but do so discreetly, Harding said.
Mental health workers also are encouraged to think of safety in terms of furniture placement, ensuring a clear path to the door.
Often, all an employee has to do to de-escalate a situation is talk calmly and listen, Harding said.
“Usually it’s letting the veteran have their say and be heard,” Harding said. “That reduces the need to have the police response.”
Macaluso noted that larger hospital facilities with more acutely ill patients might have more security measures than a smaller clinic.
Even as they discuss avoiding patient violence, mental health workers are quick to point out that people with mental illness are no more likely to be violent than other people.
According to mentalhealth.gov, run by the Department of Health and Human Services, only about 3 to 5 percent of violent acts can be attributed to people with a serious mental illness. About 4 percent of Americans had a serious mental illness in 2014.
“If you’re in an industry where you’re providing service, there’s always the possibility of escalation,” Macaluso said.
Yet inaccurate beliefs about mental illness and violence have led to stigma and discrimination against patients with mental illness, he said.
“The death of Dr. Reddy is very tragic, very sad,” Macaluso said. “I think it hits home for people in the medical field for a variety of reasons. … You hope that people will not generalize this to all patients with mental illness. That’s when people really could face stigma or discrimination, which makes the tragedy even worse.”