Occupational Violence and Aggression in Health and Social Care

We all have the right to feel safe and protected in the workplace. However, across the UK and Ireland, occupational violence and aggression is an increasingly common feature of everyday life for practitioners working in health and social care.

While the true extent of the issue may be tricky to quantify – especially as it is often under-reported – statistics from professional bodies such as the Health Service Executive (HSE) and Health and Safety Authority (HAS) in Ireland, and the Health and Safety Executive (HSE) in the UK, suggest that workplace violence and aggression is on the rise.

Statistics around occupational violence and aggression

According to Ireland’s Health and Safety Authority, almost a quarter of the 8700 workplace injuries recorded in 2022 occurred in healthcare, social care, and other related areas. There were 398 attacks on staff, and nurses, carers and social workers accounted for almost 59% of these assaults and other incidents of violence.

And in the UK, the British Medical Journal reported that rates of violence and aggression towards healthcare workers have risen sharply since the pandemic. This is supported by evidence from the UK’s Health and Safety Executive, which states that ‘violent and aggressive incidents’ are the third biggest cause of injuries reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) from the health and social care sector.

What is occupational violence and aggression?

The UK’s Health and Safety Executive and HSE Ireland’s definitions are virtually identical, stating that workplace violence is’…any incident in which a person is abused, threatened or assaulted in circumstances relating to their work.’

The main risks to practitioners in health and social care centre around verbal abuse or physical assault, with cited examples including:

• being bitten during close personal care
• verbal abuse by an individual, patient or relative
• being threatened by a patient when trying to administer medication

However, occupational violence and aggression encompasses a whole plethora of behaviours such as biting, spitting, scratching, hitting, kicking, punching, pushing, indecent physical contact, sexual harassment, online abuse, and threatening behaviour, whether physical or verbal.

Impact of occupational violence and aggression

We should not underestimate the toll that occupational violence and aggression can take on staff in the sector. It is not only the physical scars we need to consider; there are often associated psychological scars, too.

Repeatedly encountering violence and aggression at work can lead to feelings of worthlessness, low self-esteem, anger and exhaustion. Staff members’ emotional, physical, and mental wellbeing can be severely impacted, which, in turn, can affect how they feel about their role and the care they are able to offer. For some, leaving the profession altogether may be the only option.

The question is: how can we address occupational violence and aggression, and create positive, supportive environments that protect the safety and wellbeing of all staff?

Reducing incidents of workplace violence and aggression

While we can’t eliminate all risk, employers are required by law to put measures in place to protect their workforce’s health and safety.

With that in mind, there are a number of steps we can take to reduce the likelihood of harm or hurt, and work together to address occupational violence and aggression:

1: Plan for and implement staff training and development

Across our sector, we support individuals with a wide range of complex physical, emotional and mental health needs. Sometimes, they may struggle to articulate their needs to us, which can lead to confusion, frustration and, in some case, physical behaviours.

By ensuring that all staff within our organisations have access to quality, ongoing CPD opportunities around proactive, positive behaviour support and risk reduction, we can foster cultures of support and care for all. We can explore how to identify early signs and focus on de-escalation strategies to help reduce the likelihood of physical risk.

2: Prioritise robust risk assessments

We can also take action to reduce risk where possible. For example, where there are known risks, we need to ensure that these are identified and documented in robust, formal risk assessments. In unforeseen circumstances, or rapidly changing situations, we can undertake dynamic risk assessments to respond swiftly to what is going on.

It is also vital to consider individuals’ needs, and how these might best be supported. While we cannot foresee every action or behaviour, we can use what we know about a child, young person, or adult to formulate appropriate individual risk assessments and individual support plans. This allows us to adopt a proactive approach to reducing the likelihood of incidents.

3: Foster relationships with individuals

Whether it is within staff teams, between practitioners and those in their care, or between services and families, strong relationships sit at the heart of an effective organisation. When people feel seen, heard and valued for who they are, they may be more likely to engage with us during times of dysregulation, distress and anxiety, as well as when they feel calm.

For example, if the parent or carer of an individual arrives at our organisation and is visibly upset about something that has happened, we can capitalise on strong relationships to defuse escalating situations, thereby reducing the likelihood of conflict. Similarly, if we are supporting an individual who is moving towards crisis, we can use trusting, respectful bonds to reduce their distress and mitigate the chances of physical risk.

4: Establish effective post-incidents protocols

In an ideal world, there would be no incidents of occupational violence or aggression. However, if and when an incident does occur, we need to have robust protocols in place for recording and reporting these. All staff should be aware of these processes, have access to relevant recording systems, and feel confident that their experiences are acknowledged and responded to.

Establishing clear channels for post-incident debriefs is crucial. These should be carried out in a timely fashion when everyone is calm, and should take place in a safe, comfortable environment. The debrief process is not about apportioning blame or judging people’s actions; it’s about reflecting on what happened and learning from everyone’s experiences.

As a result of an effective debrief, leaders can decide on the most appropriate action. This might involve agreeing on support measures for staff affected, and updating existing policies, risk assessments, and individual support plans, to keep everyone safe in the future.

5: Create a positive, supportive environment

To ensure wellbeing and safety are protected, leaders must foster environments where staff feel safe and comfortable to reach out and ask for help from their co-workers and leadership team when required. After all, seeking support is a sign of professional strength.

There are many ways leaders can create positive, supportive environments: demonstrating decisive leadership, introducing an open-door policy, and providing regular opportunities for collaboration and collective reflection can help to foster a strong sense of unity and interdependence.

If staff feel well supported by leadership, they may be more likely to share concerns they have around any abuse, violence or aggression they are experiencing in the workplace.

Addressing occupational violence and aggression as a priority

We cannot ignore the increasingly common issue of occupational violence and aggression across our sector. It is our duty to keep staff and individuals safe and ensure that everyone is protected in the workplace. However, there is no denying it is a complex issue that needs a multi-faceted response at every level.

By taking a puzzle-solving approach to explore underlying contextual factors, setting up strong staff support networks, evaluating our existing policies and practices, and forging strong relationships across our whole community, we can come together to try and find positive solutions that keep everyone safe.