(Oct. 17, 2018) Emergency departments are our country’s health care safety-net. They are a place where the lives of the sickest individuals with the most urgent needs are saved, including for individuals with serious mental illness. In 2014, there were more than 2.2 million emergency department visits in the United States for which serious mental illness was the primary diagnosis.
However, emergency departments may also see levels of violence that threaten both the safety of physicians and the treatment of their patients, according to a recent survey from the American College of Emergency Physicians. 
Of 3,500 emergency physicians surveyed in the poll released this month, almost half have been assaulted on the job. A staggering 90% of emergency physicians have either personally experienced an assault or witnessed the assault of a colleague. Nearly 70% of those surveyed believe violence has increased in just the last five years—one-quarter say violence has increased “greatly” in that time.
The data beg the question: what has caused the uptick in cases of emergency room violence? Important considerations are numerous and varied, but the results indicate that mental illness could play a significant role. Of the 1,643 physicians who have experienced an assault, more than 40% believed more than half of the attacks were committed by psychiatric patients. Nearly one-third of physicians surveyed also cite “behavioral health patients” as a main contributing factor to emergency department violence.
Even though emergency departments are the place where individuals in psychiatric crisis when in need of treatment, a common response to the sometimes-violent behavior expressed by these individuals while there is arrest by law enforcement – a reality that the Treatment Advocacy Center represented in an infographic on emergency department outcomes for those experiencing a mental health crisis, available here . Of physicians who had been assaulted and whose hospital responded to the incident, 21% said the hospital had the patient arrested. Arrest was the second most-common response, following a mark on the patient’s medical chart for violent behavior.
When discussing violence on the part of those with the most severe psychiatric diseases, it should be noted that the vast majority of individuals with severe mental illness are not violent. However, the data generated from surveys such as that of the American College of Emergency Physicians emphasize the need to address existing treatment gaps for the most severe cases of mental illness to prevent violent encounters. In the case of one recent attack on a physician in a New England hospital, a patient became violent when told he would be held indefinitely in the emergency department simply because no psychiatric beds were available elsewhere.
For more information on serious mental illness and violence or the United States’ psychiatric bed shortage crisis, please visit the Treatment Advocacy Center’s key issue pages below:
· SMI & Violence
· Psychiatric Bed Shortages
Jessie Walthall
Research Assistant
References:
- American College of Emergency Physicians. (2018). ACEP Emergency Department Violence Poll Research Results.