CEO blog - spitting

Around a year ago I was the consultant psychiatrist on call for the last time in my career. I carried out an assessment of a patient who was very unwell. A young support worker accompanied me during this assessment. All was fine but suddenly and unexpectedly, the patient spat in his face. It was shocking and upsetting. My support worker colleague continued to do his duty with dignity. When we completed the assessment my colleague went into the adjoining room where he started scrubbing his face vigorously with a paper towel, clearly upset though trying hard not to show it.

This incident brought back a strong recollection for me. It was of one occasion from many years ago when I was spat at. What happened to my support worker colleague transported me back to that time, and the associated emotions came flooding back. I have been thinking about this ever since, wondering what I should do or say now in my role as CEO.

Then I received another reminder. A few weeks ago, my staff mentor, contacted me to express hurt and anger because she had experienced a situation where someone spat at her. She said that she is a ‘strong’ woman, but what happened was so degrading that it nearly broke her.

Spitting is a gut-wrenching assault. It is horrible for all involved. The person who spits at us must feel utterly desperate and completely disempowered. They are reduced to spitting as the only means of expression at that moment in time. For the care giver, who is trying their best to help, usually under very difficult and challenging circumstances, this is the ultimate rejection, the ultimate attack. We rarely talk about this, it is far too uncomfortable. But sadly, this is something that happens far too often to our colleagues.

I have found it very difficult to write about this. I ask myself what can be done. We can, of course, improve policies, processes and reporting. We can ask for greater help from the police, we can support sanctions and prosecution. We must do more to prevent these situations and always take the appropriate action.

Is there something else we need to be better at doing?  I think we must find a solution. When these things happen, we can do more to deal with the sadness and humiliation involved. I have recently slowly started to open up conversations about this, it always feels awkward. What I have heard from colleagues has made me conclude that there is so much more to be done to look after one another in these situations. We can attend to the need to be cared for, which exists in all of us from time to time. It is important to feel that it is all right to be really upset and it is definitely all right to have others give you comfort.

We all have a right to be treated with dignity and respect. We all also have a right to expect that those with whom we work closely will take care of us when the unimaginable happens.


  • Anon, 30/03/2019

    The most traumatising thing I have seen as a doctor was an 11 year old been brought in on a S136 wearing a spit hood, accompanied by two police officers (not in ELFT). He was hyperventilating and clammy. I'm a doctor but also an aunt of a boy with autism and ADHD and it took everything I could muster up to not cry and get on with my job. My job was to get down on the floor beside him and reassure him that he was in a hospital and not in any trouble. Police wouldn't remove the hood until he calmed ("do you want to get spat on?" Actually, at that moment that would have traumatised me far less than what I was witnessing. His breathing slowed with reassurance and the mask was taken off. Then he was just a vulnerable little boy with no family and police and doctors all around him. I fully understand that spitting is disgusting and we shouldn't have to put up with it. But equally we shouldn't be naïve to the implication of making this a police issue as they only have so many tools at their disposal and spit hoods are one of them. I know Dr Evans would never have written this article with an 11 year old child in mind but it is always worth thinking about the extreme consequences of any course of action and that is all I am highlighting here.

  • JC, 30/03/2019

    The real question to ask is why your patient felt the need to spit in your colleague's face. What on earth were the two of you doing to the poor soul to make them want to spit? What is certain is that your patient's distress was significantly worse than your colleague's. One has to assume that your patient was not able to leave the room to wipe themselves down and recover their composure. Professionals who find themselves in positions of power need to reflect on the care that their organisations provide. When patients become so distressed that they spit at a doctor, there is likely to be something seriously wrong. Rather than focusing on the discomfort suffered by their colleagues, they should attempt to improve the quality of care such that all patients are treated with dignity and respect.

  • Nazrul miah, 30/03/2019

    Recently a colleague of mine was slapped across the face whilst she was giving treatment. She had reported this to the police but the complaint was dismissed due to the patient having mental health. In my opinion I see no reason why the police should not prosecute as she was physically attacked. We greatly talk about inclusion and stgma around mental health but are we now giving president for people who have mental health to do what they want without consequences. I do beleive this is a debate that should be taking place.

  • Keith Williams , 30/03/2019

    I am so moved reading this and like you and many other care workers, how do we care and support them better? No one no matter who and what's their position should be disrespected in such degrading circumstances. So the big question is, how to protect ourselves better and to stop such incidents ever happening again? I think this will need a wider discussion ,but I am really glad you have highlighted this problem.

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