Here are a few rules aimed at reducing the kind of violence that occurred at the hospital in Maryland:
• Be sure that staff is sensitive and able to talk to patients.
• Train staff to recognize patient escalation and to search for causes before the explosion.
• Carefully select patients who are housed together on a unit. Do not risk mixing patients who truly look like they’re going to explode.
• Discharge patients who are troublemakers.
• Use daily group sessions of patients to discuss staff concerns about violence, and so on. We have learned over the last few decades to include patients in unit decision making.
These are just a few suggestions. All of us in psychiatry must pay attention to these problems. When events like this occur, they increase the stigma against psychiatry and exacerbate the ridicule too often heaped on us and our patients. So this is a community issue, and EVERY psychiatrist has a role to play in trying to discover a solution.
Dr. Fink is a psychiatrist and consultant in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia.