When I joined a psychiatry training program, part of me accepted and expected that dealing with violence and aggression from patients would be part of the job. Unfortunately, my experience turned out to be far from unique.

A 2019 meta-analysis by Liu et al. showed that 43% of doctors and medical staff reported experiencing non-physical violence, 24% experienced physical violence and 12% have experienced sexual violence or aggression from patients or their families in the past year.

The analysis found that these rates were considerably higher in emergency departments and psychiatric hospitals.

Meanwhile, a joint report of The BMJ and The Guardian into sexual abuse in the NHS revealed 35,606 incidents of sexual abuse, harassment and stalking between 2017 and 2022, almost three quarters of these incidents took place in mental health trusts.

In addition, the rates of violence and aggression against health workers have escalated since the pandemic, fueled by fear, misinformation and discrimination, at my workplace, South London and Maudsley NHS Trust, seeing violent incidents increases by 35% during the first block.

The impact of workplace violence and aggression on staff is considerable and can lead to different emotions, including anger, sadness, feelings of worthlessness, emptiness, fatigue and disturbances in sleep or eating habits.

In addition to the impact on health and well-being, these experiences of violence and abuse can cause staff to question their competence and confidence, potentially affecting workforce numbers.

Indeed, the 2019 report “Understanding Career Choices in Psychiatry” highlighted how violence and aggression from patients towards staff led to attrition in the specialty.

The financial impact is just as worrying with the cost of violence in NHS settings being close behind £83m in legal claims including compensation, staff absences, legal fees and turnover associated with burnout and mental health injuries.

However, despite their prevalence and impact, many incidents of violence and bullying in the NHS go unreported.

Findings from 2023 NHS Staff Survey revealed that 23% of respondents said no when asked if they or a colleague had reported the most recent incident of physical violence against them, and 43% said they had not reported workplace harassment, bullying or abuse.