The risk of assault against mental health professionals: a fatal case report and literature review

Assaults by patients against healthcare providers are a worldwide increasing phenomenon. Mental health professionals are at the highest risk for being attacked at work, mainly in acute facilities and rehabilitation wards. Verbal abuse or intimidating behavior represents the most common type of violence. Fatal assault by psychiatric patients has been rarely reported. We present a case of a female psychiatrist stabbed to death in her office in a Mental Health Center. At the autopsy, seventy stab wounds were found: four wounds of the supraclavicular and cervical areas, fifty penetrating wounds of thorax, three wounds of the abdomen, six wounds of the lumbar region, seven wounds of the upper arms, including defense injuries. Death was attributed to massive hemorrhagic shock. The perpetrator was a 44-year-old male patient who was referred to the victim after being previously admitted to hospital with suicidal ideation and confusion. The extreme and unmotivated violence in a not-acute setting were notable. A borderline-antisocial personality disorder was later highlighted by the psychiatric expert. This case emphasizes the significant occupational risk for mental healthcare staff to sustain life threatening injuries or even death, with implications for training of clinicians, and strategies in preventing aggressions.