We were saddened by the death of Dr. Wayne Fenton, as noted in the October 6, 2006,issue in the article "Patient Charged With Murder of Schizophrenia Expert." We appreciate the discussion regarding psychiatrists often having to make difficult clinical decisions relating to a lack of inpatient facilities, concerns about the efficacy of a referral to the local emergency room, as well as the best way to treat a patient while maintaining appropriate boundaries. However, the topic of defending oneself needs some additional recommendations.

First, many facilities offer courses on nonviolent negotiation techniques and nonaggressive forms of escaping a violent situation. This training should be included in every psychiatry residency, as it is just as important as education relating to business management, malpractice insurance, and CPR.

Unfortunately, simple avoidance of an aggressive act may not inhibit the patient-turned-perpetrator from continuing his or her assault. Therefore, we would encourage psychiatrists to consider taking some form of minimal self-defense training. Without a doubt, the initial goal even for those with a martial arts background is prevention and escape. If this option is not possible, however, the ability to utilize a few self-defense techniques may serve as an additional deterrent and possibly be life saving.

The suggestion to learn some self-defense techniques may appear alarmist and controversial. We do not intend to perpetuate the myth that mental health patients are more dangerous than the general public. Our experience suggests, however, that as a profession, we are woefully unprepared regarding this safety concern.