A systematic search for accounts describing homicides of mental health workers between 1981 and 2014 was conducted. Demographic characteristics of the mental health workers and clinical characteristics of the perpetrators were collected. These data revealed that homicides occurred at a frequency of approximately 1 per year. Young women caseworkers who were unaccompanied during visits to residential treatment facilities were the most common victims. Men with a diagnosis of schizophrenia were the most common perpetrators. The most likely method of homicide was by gunshot (42.4%), but 57.6% of homicides were committed by less lethal, and possibly preventable, means. Perpetrators often had a prior history of violence, criminal charges, involuntary psychiatric hospitalization, or nonadherence to medications. After their legal trial, perpetrators were more likely to be imprisoned than hospitalized. Strategies to accurately identify risk and to train acute care staff in possible prevention measures are much needed. Some policy and training recommendations are offered in conclusion.
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