Violence at work.

Violence appears to be increasing within our society along with a disregard for property as illustrated by the recent incidents on estates in Britain. The definition of violence varies and may include deliberate self-harm (DSH), damage to property, verbal abuse, threatening behaviour and physical attacks on persons or on staff (Shader et al., 1977; Fottrell, 1980; Ruben et al., 1980; Bouras et al., 1982; Dietz & Rada, 1982; Tardiff, 1983; Aiken, 1984; Hodkinson et al., 1985; Werner & Bouras, 1988). It has been recognized that Health Care Workers are at risk of violence in their working environment (Health Services Advisory Committee, 1987; DHSS Advisory Committee on violence to staff 1988; Harrington, 1990). A recent report by the National Union of Public Employees (1991) showed that 87% of those respondents to a questionnaire were worried about violence in their work, i.e. in a hospital setting. Few (43%) of the hospitals had a policy on violence, only 3% of hospitals offer special training to all staff and up to 50% give no training. Only 25% of the hospitals had advised staff on the procedure to report incidents. Much of the chronic under-reporting was of verbal abuse or threats. Under-reporting of assaults has been noted in previous studies (Lion et al., 1981; Conn & Lion, 1983). A review by the author of incident forms in the Accident and Emergency Department of University College, London confirmed under-reporting of such events. Staff reported serious physical attacks or incidents relating to possible medical consequences in this case exposure to blue asbestos; but not verbal abuse. Other studies also show serious incidents being reported (Wenk et al., 1972; Infantino & Mustingo, 1985). Explanations that have been offered for under-reporting include the fact that the frequency is so high that it is not reported; that report filling is tiresome and staff see no change as a result of it and; staff fear serious accusations of negligence and inadequate performance (Conn & Lion, 1983; Lion et al., 1983). Doctors on call for psychiatry at University College Hospital Accident and Emergency Department had not filled in incident forms although there had been