When a man opened fire at a hospital outside Philadelphia, fatally shooting his caseworker and wounding his psychiatrist, the doctor saved his own life and probably the lives of others by pulling out a gun and shooting the patient.
If Dr. Lee Silverman’s decision to arm himself at the office was unusual, the violence that erupted at Mercy Fitzgerald Hospital served as yet another illustration of the hazards mental health professionals face on the job — and, experts say, the need for hospitals to do more to protect them.
Nurses, social workers, aides and other mental health care providers are at far greater risk of assault than workers as a whole, an occupational hazard at the best of times and one that’s been made worse by a persistent lack of funding for mental health services, the loss of thousands of inpatient psychiatric beds and the increasing use of hospitals to temporarily house criminals with mental illness.
Many health care facilities have failed to provide a safe working environment for their employees, workplace violence experts said.
“Hospitals don’t want to have a reputation as being the wild, wild West,” so they “try to minimize it and keep it quiet,” said Dr. William Dubin, chairman of the psychiatry department at the Temple University School of Medicine, who has written about violence against mental health professionals.
The great majority of people with mental illness are not violent, noted Gabriel Nathan, spokesman for Montgomery County Emergency Service, a private psychiatric hospital outside Philadelphia.
“Unfortunately, as in all populations, there are outliers,” he said, “which is why it is important to be aware and alert.”
A Department of Justice survey found 55,882 workplace violent crimes against psychiatrists, social workers and other mental health professionals from 2005 to 2009, making them four times as likely to be assaulted on the job as workers generally.
Independent experts said the number of assaults is almost certainly far higher because violent incidents are grossly underreported.
That reluctance often stems from a belief among mental health care providers that violent outbursts come with the territory, or a fear they’ll be blamed for provoking the attack or an unwillingness to turn in someone they’re trying to help. And health care administrators often discourage reporting, experts said.
“No one wants bad publicity that potentially comes from workers reporting that they suffered” an assault, said University of Maryland professor Jane Lipscomb, who researches occupational injuries in health care. “That’s a huge barrier.”