Assaults and threats on psychiatrists

Sir: Recent papers on psychiatrists' safety raise important issues. Davies reaffirms the view that psychiatrists are vulnerable to violence (Psychiatric Bulletin, March 2001, 25, 89-91). Osborn and Tang demonstrate the ineffectiveness of audit in ensuring that interview rooms are safe (Psychiatric Bulletin, March 2001, 25, 92-94).

While we welcome their emphasis on training and audit, we should be clear that NHS trusts, like all employers, have a duty under the Health and Safety at Work Act 1974 to ensure the health, safety and welfare of their employees (Health & Safety Executive, 1989). Responses should be dynamic but despite the fact that violence is common, monitoring systems are frequently lacking. Osborn and Tang describe mechanisms that may explain the poor response, concluding that clear action plans should be formulated with responsible individuals identified to oversee the process. Without regular review by those responsible, change is unlikely.

Royal College of Psychiatrists training approval visits provide opportunities to influence this process. The College has put junior doctor safety high on the agenda and has produced a clinical practice guideline (Royal College of Psychiatrists, 1998). Trusts take approval visits seriously — not least because of the impact of loss of training status. The response to these visits is often to deal hurriedly with problems, many of which have been unresolved for years. Unfortunately, if Osborn and Tang are correct, this activity will rapidly tail off, only to be reactivated prior to the next visit.

We propose that the Royal College of Psychiatrists should introduce mechanisms that increase the likelihood of safety issues remaining high on trust agendas. The College should develop an audit tool based on the clinical practice guideline. This would form the basis of review at approval visits. Between visits, the tutor could undertake an annual audit, with the results reported to the approval team convenor. Deterioration in performance would trigger an interim visit focusing on safety issues.

By taking a proactive role in assessing not only the quality of teaching, but also the safety of the environment, the College would ensure that trusts discharge their legal responsibilities effectively.