Exploring the perceived threats of violence from male state patients against support staff in a Psychiatric Inpatient Facility in Gauteng South Africa

Abstract

This qualitative, exploratory study sought to determine whether non-clinical staff, generally referred to as “support staff”, perceived their working environment – a psychiatric inpatient facility in Gauteng – as threatening and, if so, whether this perception could be attributed to constant exposure to male state patients (“MSPs”). The MSPs have a history of violence, with charges of assault with an intent to do grievous bodily harm, rape and murder being the most prevalent. Support staff members (ward clerks, administrative staff, cleaners and groundsmen), encountered MSPs during the execution of their daily duties, but appeared to receive little or no training which could foster the skills needed to interact safely with potentially dangerous MSPs. Data was obtained through in-depth interviews and semistructured interview guides were used. Twelve participants were recruited through purposive sampling and three key informants provided additional data to support triangulation. During thematic analysis, it emerged that patient unpredictability, having experienced direct threats, having experienced vicarious trauma, an apparent lack of security measures and lack of support from clinical staff and management contributed to the participants’ perception of the threat of violence. Findings suggest that frequent exposure to MSPs elicited fear in some of the support staff. Participants expressed the desire for improved security measures, comprehensive training and general education about mental illness in order to empower themselves to better understand mental illness. Moreover, occupational social workers (“OSWs”) have a vital role to play in bridging the gap between management and staff, and empowering vulnerable employees. An OSW framework to ensure Employee Wellness and Safety in Safety-Sensitive Environments was designed from the output of this study which might be useful in other safety-sensitive settings.