Patient vs. Doctor

On Tuesday night, a man wielding a meat cleaver and other knives killed 56-year old psychologist Kathryn Faughey and seriously wounded her 70-year-ld colleague in their Manhattan office, leaving behind a bizarre collection of clues in the building's basement, including adult diapers, women's clothing, rope, duct tape and additional knives. Though police say they are not currently focusing on the theory that the killer was a patient of the victim, the act brings to mind a disturbing set of questions about the risks taken on by those who spend their days treating mentally ill patients.

The concerns are real. Fifteen years ago, the MacArthur Violence Risk Assessment Study concluded that 30 percent of the psychiatric patients tracked had committed at least one act of violence after being discharged, ranging from relatively minor attacks like biting and hitting—which constituted about half of the incidents—to rape and murder, in rare cases. In 2001, Gary Arthur and Joel Brende, professors emeritus at Georgia State University and Mercer University School of Medicine, respectively, found striking evidence of workplace safety concerns for mental healthcare providers: Of the 1,131 therapists who responded to his survey, 14 had been shot at, 6 knifed, 209 shoved, and 87 hit by objects thrown at them by patients.

NEWSWEEK's Katie Paul talked about the risks facing mental health professionals with Dr. Spencer Eth, a forensic psychiatrist who directs the Behavioral Health Services at St. Vincent's Medical Center in Manhattan and teaches as a professor of psychiatry at New York Medical College. Excerpts:

NEWSWEEK: How common is violence against mental health professionals? And to what extent is this a known occupational hazard?
Spencer Eth: Assaultive behavior is not uncommon. Thankfully, murder is quite rare. In the course of a career, more than half of therapists sustain some kind of injury, but minor injuries are much more common. There are significant differences in the type of practice: psychotherapists versus psychiatrists, those who work in office settings versus those who work in in-patient units in emergency rooms. It also depends a lot on the kind of practice one has, so the incidence of violence differs considerably. If one has a more traditional psychotherapy practice, working with employed people who are generally high-functioning with neurotic-type anxiety or depression, that is a relatively safe situation. If you're talking about a therapist or psychiatrist who works with criminals, or alcohol or drug abusers, or people who are psychotic, with a history of aggression, then that work can be quite dangerous.

Have you experienced incidents of violence in your own practice?
I'm hospital-based, so we have a very different kind of patient population. We have staff and security guards around, as all hospitals do, so it is a safer setting for extreme violence, but more common setting for assault. In fact, ERs and psychiatric units are associated with a substantial degree of staff injury, but very rarely lethal.

So it's more likely that incidents occurring in small practices will result in extreme violence?
Yes, because one could be quite alone in a setting where there are no metal detectors or security guards.