A Psychiatrist’s Worst Nightmare? Psychiatrist Stabbing Raises Concerns

November 2, 2009

A clinic for patients with bipolar disorder at Massachusetts General Hospital (MGH) was the scene of yet another attack by a patient on a psychiatrist.

A clinic for patients with bipolar disorder at Massachusetts General Hospital (MGH) was the scene of yet another attack by a patient on a psychiatrist.


According to a report in the October 28, 2009 issue of  the Boston Globe,1 the 37-year-old perpetrator, Jay Carciero, who was a patient at the clinic, stabbed his psychiatrist, Astrid Desrosiers, MD, during a treatment session. Screams coming from the treatment room caused other patients to panic and run. An off-duty security guard who did not work at the hospital but who happened to be nearby and who witnessed the chaos broke into the treatment room and ordered Carciero to drop his knife. When Carciero failed to do so, the security guard (who was armed and who had a license to carry a weapon) filed several shots that proved fatal.


Dr Desrosiers, an instructor of psychiatry at Harvard Medical School, was in stable condition at MGH. She is also the medical director of the Haitian Mental Health Clinic at the Cambridge Health Alliance and on staff at the Bipolar Clinic at MGH.


There is no national reporting system to which psychiatric facilities or hospitals must report incidents of violence against mental health professionals, so the number of attacks on psychiatrists in this country is not known. Nevertheless, according to Professor Ralph Slovenko in an article in Psychiatry and the Law, violent attacks on mental health professionals are a growing concern.2 Slovenko wrote “According to the Department of Justice’s National Crime Victimization survey, mental health professionals rank seventh and mental health custodial workers rank tenth in the occupations most at risk for violent workplace crime. Other statistics reveal that more assaults occur in health care and social services than in any other industry.”

 

In an article published in Psychiatric Times that followed the 2008 slaying of New York psychologist Kathryn Faughey and the attempted murder psychiatrist Kent Shinbach, forensic psychiatrist William H. Reid, MD, MPH noted that “fatal attacks on clinicians such as psychiatrists and psychologists are rare.”3 However, “most mental health professionals deal with hundreds of patients, at least every year, and many thousands over a career." Reid added that attacks occur in hospitals, offices, clinicians’ homes, and public places. He noted that up to 65% of psychiatry residents are physically assaulted by patients.4 In a 2003 survey of employees of the University of Rochester Medical Center’s inpatient and outpatient services, 40% of responding physicians, 3% of psychologists, and 57% of registered nurses said patients had assaulted them.5 In outpatient settings, a survey found that 32 of 92 psychiatrists (35%) reported serious assaults by patients (knife or gun used) and 59 respondents (64%) reported less serious assaults.6


What can you do to protect yourself? Psychiatric Times has compiled a list of articles on the topic to offer guidance.
 

Suggested Articles fromAdditional Resources

Firearms and Mental Illness

Book Review: Textbook of Violence Assessment and Management

Risk Management for the Supervising Psychiatrist

Assessing Violence in Patients: Legal Implications

Violent Attacks by Patients: Prevention and Self-Protection

Assessing Violence Risk in Psychiatric Inpatients: Useful Tools

AAFP Curbside Consultation: A Potentially Violent Patient?

Violent Patients in the Emergency Setting

Dangerous Liaisons: Managing Violent Patients

JAMA Book Review: Understanding and Treating Violent Psychiatric Patients

Merck: Psychiatric Emergencies

NEJM: Patient Violence and the Clinician

References:

References


1. Abel D, Cramer M. Doctor stabbed, attacker killed. Boston Globe. Oct 28, 2009.

2. Slovenko R. Violent attacks in psychiatric and other hospitals. Journal of Psychiatry and Law. Summer 2006;249-256.

3. Kaplan A. Violent attacks by patients. Prevention and self-protection. Psychiatric Times.

4. Shoemaker EZ. Safety training for medical students during their psychiatry clerkship. Presented at: 160th Annual Meeting of the American Psychiatric Association; May 19-24, 2007; San Diego.

5. Privitera M, Weisman R, Cerulli C, et al. Violence toward mental health staff and safety in the work environment. Occup Med (Lond). 2005;55:480-486.

6. Dubin WR, Wilson SJ, Mercer C. Assaults against psychiatrists in outpatient settings. J Clin Psychiatry. 1988;49:338-345.