17 March 2023 at 6:00 a.m. EDT
This database of workplace injuries is incredibly detailed and offers a concise but comprehensive portrait of tragedy and mishap in the American workplace. It tells us how often workers are suffocated by another person and how often they are caught in moving machinery. It records dutiful injuries caused by horseplay (which, the government helpfully notes, includes “roughing”) and walking (without other incidents), along with injuries to people who accidentally Taser themselves (a risk to a limited subset of workers).
When we dove into the database, which is powered by an annual survey of 230,000 employers by the Bureau of Labor Statistics, the good news immediately rose to the top: We’re getting hurt less at work.
But the deeper we dug, the more desperate we became. The decrease in occupational injuries occurred primarily in the largest categories: Overexertion injuries, including injuries caused by heavy lifting. Repetitive strain injuries. Slips and falls. Contact injuries, which typically involve being hit by something, like a piece of equipment.
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(In 2020, the most recent year for which we have data, the leading cause of injury was actually exposure to harmful substances, a category of workplace hazards that skyrocketed during the Covid pandemic. But workplace exposure to coronavirus is really another story Our Post colleagues have dealt with it elsewhere in impressive depth.)
Another main category, injuries caused by people or animals, remained flat. Or at least that’s how it seemed at first. In fact, the flat line hid two divergent trends: A sharp decline in people accidentally harming each other. And a huge increase in injuries caused by intentional attacks in the workplace.
The number of intentional man-made injuries just keeps on increasing. Every year, more and more Americans are punched, kicked, punched, or pushed so hard that the victim misses at least one day of work. (Injury rates fell in 2020 as many of us were socially distanced and working from home, but the broader trend is ominous.)
To understand who is being attacked, we analyzed the largest category – punching, kicking, beating, pushing – by gender. The gap was alarming. Not only are women far more likely to be assaulted and injured so badly that they miss work, but almost all of the past decade’s increase in hitting, kicking, punching and shoving in the workplace has been directed at women.
What happens? On deeper investigation, we discovered that only a handful of major occupational groups are at real risk of being attacked by other people at work: Education and health professionals and a broad group of service workers that include everything from domestic helpers to chefs.
But which of these jobs drove the increase?
Based on the overall injury rate, the most dangerous job is the athlete, a fact not lost on fans and players anxiously awaiting the latest sports injury reports. But athletes are not attacked. They are most often injured accidentally by others or succumb to slips and falls.
Narrowing our focus to the most dangerous jobs, where violent attacks are the biggest cause of injury, is revealing. These jobs are much lower profile and much less generously compensated. No. 1 on that list — and the second most dangerous job overall after athlete — is psychiatric aide, a position that cares for patients with mental illness or disabilities, often in psychiatric hospitals. It is followed by psychiatric technician, a role that has similar but more specialized responsibilities. Both occupations paid significantly less than $40,000 a year in 2021.
“They are often what the punching bags are for [patients] because they don’t have any defensive tactics training, they don’t have any weapons on them, they don’t have anything like that,” said Coby Pizzotti, who has worked with the California Association of Psychiatric Technicians for more than a decade. “They are just there to treat these patients.
“So what they end up seeing are horrible, horrible things. And what they end up suffering are unbelievably horrible events,” Pizzotti said. “We have many psychologists who have been beaten so badly that they cannot return to work.”
As it turns out, about 4 out of 5 psychiatric technicians are women. We are used to seeing lists of the most fatal jobs, which are dominated by largely male occupations such as fishing, logging and roofing. But a job can be extremely dangerous without being deadly. And when we rate dangerous jobs in terms of injuries rather than deaths, jobs dominated by women rise to the top.
That fact becomes apparent when we map the workplaces where the number of injuries caused by violent attacks is increasing. Teaching assistants, personal care assistants, psychiatric assistants and technicians, elementary school teachers and registered nurses top the list. Every last one of these professions is mostly done by women.
Meanwhile, the jobs with the biggest drop in assaults – police officers, corrections officers and police inspectors – are all largely held by men.
But why the increase? We started with education workers. Research into school violence previously primarily focused on students. But the past 15 years have seen an increased focus on violence against teachers, said psychology professor Susan Dvorak McMahon of DePaul University in Chicago, chair of a school violence task force that recently briefed Congress on the issue.
McMahon told us she wasn’t surprised that such attacks have increased. It takes experience and training to defuse abusive situations with students, parents and even colleagues, and many front-line education positions have high turnover. Our analysis of Bureau of Labor Statistics data shows that teacher aide turnover skyrocketed between 2010, when the typical aide had been on the job 5.6 years, and 2020, when the typical aide stayed on the job for just 3.2 years .
“There is definitely a correlation between violence and victimization and teacher turnover,” McMahon said.
Next, we turned to mental health aides and technicians, the people who most often face being grabbed, scratched, bitten, choked, punched, kicked, pushed and spat on at work. There is no smoking gun that explains why their work has become increasingly dangerous, said Jack Rozel, professor of psychiatry at the University of Pittsburgh, who leads meetings and trainings on workplace violence in psychiatric hospitals, in addition to treating patients enduring psychological crises.
But Rozel noted a critical source of trouble with these jobs: The skills needed to handle high-risk patients are developed only through training, experience and mentorship. But the riskiest jobs facing patients are low-paying, entry-level positions that don’t inspire workers to stay long enough to learn them.
“It is technically demanding, emotionally challenging work. It takes time to get good at it,” Rozel told us. “The challenge is to find a way to learn how to deal with someone who is upset or threatening or potentially violent that doesn’t involve the staff or the patient getting hurt in the process.”
The vast majority of people living with psychiatric illness are not violent, Rozel told us. But there are, he said, a few people with illnesses and life experiences that put them at higher risk for violent behavior. That risk increases when they fall through gaps in the frayed social safety net and are allowed to get sicker and sicker before reaching the hospital.
Elizabeth Sinclair Hancq leads research at the Treatment Advocacy Center, a nonprofit organization working to improve care for those with serious mental health problems. She says that as the country’s capacity to treat the seriously mentally ill has declined, particularly in state-run facilities, it has become harder for people to access care.
Many patients only enter a treatment facility when their symptoms have become so severe that they pose a danger to themselves or others. To that point: A growing share of the state’s psychiatric patients are connected to the criminal justice system, either because they are awaiting trial or have been found not guilty by reason of insanity, Hancq’s research shows.
“As psychiatric beds decline, so does the ability to access beds,” Hancq told us. “So patients who end up being admitted to an inpatient unit have higher levels of acuity – higher levels of more severe symptoms – which are known to also correlate with increased seizures and violent and aggressive behaviour.”
Future data releases on occupational injuries may paint an even darker picture. During the pandemic, patients have been admitted, dangerous behavior has increased across the board and psychiatric beds was further restricted to make room for covid patients.
The nation is also experiencing a massive shortage of workers willing to do such dangerous and traumatic work – most of them women.
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