Psychiatric Views on the Daily News - Episode 216

In Memoriam: A Thanksgiving Eulogy for a Valued Psychiatric Nurse Practitioner

June Onkundi, a nurse practitioner, was killed by one of her patients.

PSYCHIATRIC VIEWS ON THE DAILY NEWS

If a mental health care system knew that a prospective patient had 5 previous incarcerations, each related to violence against women, should that person be assigned to a female clinician? I think not, especially given that previous violence is the best predictor for future violence.

Unfortunately, a recent tragedy seems to have proceeded otherwise. Although so many details seem missing from the public media reports, what we do know from the news is that a female nurse practitioner named June Onkundi was stabbed to death by her patient outside of the clinic where she worked on Tuesday afternoon, October 18th, 2022. Possibly due to legal confidentiality, we do not know how the patient became her patient, the nature of the treatment, and whether there were bystanders.

This case was brought to my attention via the psychiatric nurse practitioner (NP) liaison to Psychiatric Times™ for a possible eulogy. Usually, our eulogies are for psychiatrists who come to my attention for personal or professional reasons. There have been exceptions, such as the neurologist Oliver Sacks and the actor Robin Williams. Should this be an exception?

Then I thought back to the tragic killing of the well-known psychiatrist Wayne Fenton by a new patient in September 2006. This occurred on a weekend where he was alone in his office with this new patient who had symptoms of psychosis and paranoia.

Since this NP case may have some similar implications for preventing violence by patients, it has educational importance. Moreover, so much of community psychiatry is dependent on multidisciplinary staff, and it is misleading to only—and always—focus on psychiatrists. Surely, if a psychiatrist in this situation had been killed instead, there would be no question about doing a eulogy.

In addition, the supply of psychiatrists is limited and inadequate to take care of all our mental health care needs in the United States. Social workers are needed for psychotherapy and the social needs of our patients; psychologists also provide psychotherapy and psychological testing; NPs can provide both psychotherapy and medications, as can primary care physicians.

Of course, some of us will feel that there is some unnecessary competition in areas where we have the expertise. Then again, besides the limited number of psychiatrists, psychiatrists have varying depress of expertise and quality of care.

All of us in mental health care supplement each other in caring for patients and ourselves. To prevent violence, not only is careful risk assessment necessary, as well as adequate security, but we should avoid being alone without the ability to immediately call for help. That risk can take place outside of a clinic too, as in the current case. When I worked part-time in a prison, we were told not to wear a tie or shake hands with the male patients.

Second, we should make the best use of our overlapping and diverse skills. Especially with those more severely ill, a multidisciplinary approach is generally best.

Lost in all this justification and explanation is the tragic loss of life by this NP. Though her caring was praised, I could only obtain limited information about her.

As Thanksgiving approaches, let us give thanks for June Onkundi and all our colleagues regardless of discipline.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.