Comment on “Violence Against Psychiatric Trainees: Findings of a European Survey”



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To the Editor:

Pereira-Sanchez et al. (2021) in their paper raise important and timely questions regarding violence by patients against psychiatry trainees. An overwhelming majority of trainee respondents from Europe reported that they had experienced some form of violence by their patients [1]. Not surprisingly, this led to a lasting impact on their mental well-being. A recent report of high vulnerability and psychological concerns among trainees and young physicians [2] makes it clear that the profession has an obligation to improve working and training conditions but also to provide immediate and appropriate assistance to the trainees be it psychological or medical especially to those who need it. However, as the authors [1] point out, the number who reported the assault was very low. This may have been due to their perception that the incidence was not serious enough, or that their supervisors will not take it seriously thus avoiding reporting.

In an international study, we aimed to explore the experiences of early career psychiatrists in working within the current legal framework of compulsory psychiatric care and detention of patients in their countries of practice along with potential areas for revision [3]. We also explored their experiences of physical aggression towards them by their patients. In this international, cross-sectional and anonymous online survey, 142 psychiatrists from 43 countries (52.8% females; mean age 32.6±3.9) responded. Of those, 38 (26.8%) were psychiatry trainees. A majority of our respondents (78.2%) had reported a history of physical attacks by patients. Almost a quarter (22.5%) of these attacks were reported as life-threatening. Almost two-thirds (64.7%) of the respondents did receive psychological help or supervision after the episode, the rest did not. Peer support was offered in 46.8% and/or from their senior colleagues in 32.4%.

Both studies have been conducted during the same time period. They highlight an urgent need for support by both clinical and educational supervisors at a personal level. But training institutions have a moral obligation to provide appropriate training and supportive environment. A worrying finding is that one third of early career psychiatrists did not receive any help, findings similar to in earlier study [4]. In order to manage the aftermath of violent attacks, urgent action is needed not only to train everyone in breakaway techniques but also have immediate access to support were these incidents to happen. The institutions must implement/adopt hospital and emergency room polices to prevent the violence from occurring. We recommend that they must have clear policies but also wellbeing guardians who can be approached by those affected and act as a repository of information. They can provide support to prevent burnout and long-term distress thus avoiding psychological consequences. At a governmental level, policies and resources must be allocated so that trainees are looked after. Regulatory bodies have an ethical obligation to ensure that the workforce are looked after so that they can provide care to patients properly.

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About the authors

Егор Максимович Чумаков

St.-Petersburg Psychiatric Hospital №1 named after P.P. Kaschenko, 190121, St. Petersburg, Kanonerskaya str., 12;
Saint-Petersburg State University, 199034, St. Petersburg, Universitetskaya nab., 7–9

Author for correspondence.
Email: chumakovegor@gmail.com
ORCID iD: 0000-0002-0429-8460
Russian Federation

Nataliia Petrova

The Head of Department of Psychiatry and Addiction, Saint Petersburg State University

Email: petrova_nn@mail.ru
ORCID iD: 0000-0003-4096-6208
SPIN-code: 3341-2372
Russian Federation

Ramya Vadivel

Advanced Trainee Registrar, Waikato Hospital

Email: dr.ramya.v@gmail.com
ORCID iD: 0000-0002-7055-5250
New Zealand

Dinesh Bhugra

Professor Emeritus of Mental Health and Cultural Diversity, Institute of Psychiatry, Psychology & Neuroscience, Kings College London

Email: dinesh.bhugra@kcl.ac.uk
ORCID iD: 0000-0002-0613-2480
United Kingdom

Antonio Ventriglio

Department of Clinical and Experimental Medicine, University of Foggia

Email: a.ventriglio@libero.it
ORCID iD: 0000-0002-3934-7007
Italy

References

  1. Pereira-Sanchez V, Gürcan A, Gnanavel S, Vieira J, Asztalos M, Rai Y, Erzin G, Fontaine A, Pinto da Costa M, Szczegielniak A. Violence Against Psychiatric Trainees: Findings of a European Survey. Acad Psychiatry 2022 Apr;46(2):233-237. doi: 10.1007/s40596-021-01539-3
  2. Bhugra D, Sauerteig SO, Bland D, Lloyd-Kendall A, Wijesuriya J, Singh G, Kochhar A, Molodynski A, Ventriglio A. A descriptive study of mental health and wellbeing of doctors and medical students in the UK. Int Rev Psychiatry. 2019 Nov-Dec;31(7-8):563-568. doi: 10.1080/09540261.2019.1648621.
  3. Chumakov E, Petrova N, Vadivel R, Pinto da Costa M, Bhugra D, Ventriglio A. Use of Compulsory Treatment by Early-Career Psychiatrists: An International Survey. Psychiatr Serv. 2021 Nov 1;72(11):1276-1281. doi: 10.1176/appi.ps.202000303.
  4. Cannavò M, La Torre F, Sestili C, La Torre G, Fioravanti M. Work Related Violence As A Predictor Of Stress And Correlated Disorders In Emergency Department Healthcare Professionals. Clin Ter. 2019 Mar-Apr;170(2):e110-e123. doi: 10.7417/CT.2019.2120.

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Copyright (c) Чумаков Е.М., Petrova N., Vadivel R., Bhugra D., Ventriglio A.

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