Mental Health Workers Frequently Risk Assault at Work

Erin L. Kelly PhD Post Doctoral Scholar Health Services Research Center University of California, Los Angeles, Interview with:
Erin L. Kelly PhD Post Doctoral Scholar
Health Services Research Center
University of California, Los Angeles, California

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kelly: Mental health facilities can be hazardous workplaces. Nationally, compared to their counterparts in other healthcare settings, mental health workers are at the highest risk for patient assaults. Many studies have focused on predictors for assault such as gender, years of experience, or the position that staff hold in the hospital, which can account for a small amount of violence. However, psychiatric care is largely about relationships. Our study examined how conflicts with patients and coworkers, and how people react to conflict, influences their risk of assault.

In our study, 70% of staff at a large public mental hospital were assaulted in a single year, which is closer to the lifetime assault rate for mental health workers. We also found that the likelihood of assault is predicted by conflicts when we also include stress reactions to conflict as a moderator. We found that workers who reported being less reactive to conflict but experienced a great deal of conflict, with staff or patients, were at the highest risk of assault. This could mean that people who aren’t afraid of conflict with patients are more likely to jump in with agitated patients or that people who are insensitive to conflict are missing important social cues and being assaulted more often. However, despite the similarity in the relationships of staff conflict and patient conflict with assault risk, it’s possible that the direction of the relationship between staff conflict and assault may be different. For example, mental health staff who have a lot of conflict with their co-workers may be isolated and therefore a target for assault by patients.

MedicalResearch: What should clinicians and patients take away your report?

Dr. Kelly: Even though people with mental illnesses are not generally more violent than those without mental illnesses, the prevention of violence and conflict are important for the safety of mental health workers. The ways that mental health workers interact with coworkers and patients can have important implications for their safety. By focusing on the conflicts that can precede assaults and how staff react to conflict, hospital administrators can improve the working conditions for their employees.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Kelly: Future research should examine how staff react to conflict and assault and how those reactions impact their well-being and safety. An examination of how social support after assault impacts reactions could also be important. Longitudinal research could also help to clarify the relationships between staff conflict and patient assault.


Kelly E.L., Subica A.M., Fulginiti A., Brekke J.S. & Novaco R.W. (2014) A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. Journal of Advanced Nursing 00(0), 000000. doi: 10.1111/jan.12609

[wysija_form id=”1″] Interview with:, Erin L. Kelly PhD Post Doctoral Scholar, & Health Services Research Center (2015). Mental Health Workers Frequently Risk Assault at Work