Psych meds increase with workplace violence
Drop back to baseline within 3 years
After hospital workers encounter workplace violence, their medication use goes up, but there is no change in their visits to mental health counselors, according to a new study. Instead, they may be receiving much-needed emotional support from employee assistance programs.
Researchers assessed hospital workers after a physically violent act committed by a patient or visitor. They found that employees had an increased use of psychotropic drugs (i.e. Prozac).1 However, employees did not seek increased use of mental health services.
"We think there was not an increased risk for utilization of mental health services partly because the three institutions in our study have long-standing employee assistance programs," says John Dement, PhD, professor in the division of occupational and environmental medicine, department of community and family medicine, Duke University Medical Center, in Durham, NC. Dement was the lead author of the study.
"These institutions made their services at no cost to employees and were available for a short time following the event," Dement explains. "Our analysis supported that as a means of mitigating workplace violence."
Building trust in the employee assistance program is important so employees feel comfortable accessing services after incidents of workplace violence, Dement notes "It has to be staffed by professionals, including mental health professionals, and the model has to be more than a couple of visits," he says. "At Duke we have an eight visit model, although most of the cases are resolved in five or six visits."
The finding of increased use of psychotropic drugs related to a pattern in which there was a short-term increase in use. Within three years, the use dropped back to baseline levels, Dement says.
"Most of these psychotropic drugs were prescribed by non-mental health professionals," he adds. "A lot is being done by family doctors."
The study was part of a larger research project that looked at risk factors for workplace violence in health care settings and how to develop better mechanisms for reporting these events, Dement explains.
"This sub-project was to look at impact," he adds. "We used a data set that came from health claims and pharmacy claims; the violent acts information came from reporting systems at the institutions."
The study data spans 12 years, from 2001 to 2013, and includes 9,884 workers and employees, and 387 workplace violent events, Dement says.
The study also points to the need for additional prevention programs to prevent or minimize the severity of these violent events, he adds.
"OSHA has published a nice document, intended not as a compliance document, but as an informational piece, with guidelines for health care workers," he says. "It outlines strategies that are useful in the health care setting for either preventing or reducing the impact of these events when they occur."
The OSHA guidance suggests hospitals conduct a simple survey, asking workers about the risk of violence.2 Here are a few examples of the questions:
• What do they see as risk factors for violence?
- The most important risk factors in their work areas;
- Aspects of the physical environment that contribute to violence;
- Dangerous situations or "near misses" experienced;
- Assault experiences past year, entire time at facility; and
- Staffing adequacy.
• How are current control measures working?
- Hospital practices for handling conflict among staff and patients; and
- Effectiveness of response to violent incidents.
Researchers concluded that mental health counseling, provided through employee assistance programs, is key to minimizing the effects of workplace violence.
"There needs to be something in place," Dement says. "These events are daily occurrences, so the programs need to be an integral and ongoing part of the institution."
- Dement JM, Lipscomb HG, Schoenfisch AJ, et al. Impact of hospital type II violent events: use of psychotropic drugs and mental health services. Am J Ind Med 2014:epub ahead of print.
- OSHA. Guidelines for preventing workplace violence for health care & social service workers. OSHA 3148-01R;2004:1-47.
