Working Under Fire: Examining the Mental Health Consequences of Community Violence Among Health Professionals in Mexico

Background and Purpose: Mexico has lived through prolonged endemic violence caused by organized crime and the war on drugs. This qualitative study explores the mental health effects of violence on health care professionals. While there is some empirical evidence of the negative effects of violence for health, little is known about how the mental of health professionals working in contexts of high violence is affected. This paper fills a gap by examining the accounts of health professionals that have had direct exposure to violence in their work environments and communities.

Methods: Eighty semi-structured interviews were conducted with physicians (72%) and other health professionals (28%) including social workers, psychologists and nurses located in five states of Mexico selected for their high incidence of violence. The sample is predominantly male (66%). This study used snowball sampling through local public health agencies and recruitment was in person as well as through telephone or email.

Interviews focused on how violence affects health professionals directly and their ability to provide services to the community, focusing on perceptions of direct or indirect effects that have professional, mental or emotional (and sometimes physical) consequences for these individuals. Interviews were conducted in Spanish, recordings were transcribed, and coded thematically using ATLAS.ti qualitative software, framework analysis was used to interpret key themes and findings.

Findings: Organized crime has targeted medical professionals for kidnapping or extortion because they are thought to earn more money. Doctors have had to temporarily or permanently close their private practices, negatively impacting their earnings. Health professionals in all five states have been regular targets of threats of violence, sometimes by armed individuals inside medical facilities. In some hospitals, health professionals have had to witness executions of gunshot victims. Some doctors have been kidnapped by organized crime groups to attend to their own victims of violence. Fear is very prevalent among health professionals serving in communities where violence is high. Several health professionals reported having anxiety and nervousness, feeling paranoia, and not knowing how to deal with patients who themselves were seeking primary care services for mental health problems related to community violence. Health professionals reported that there is no formal support for mental health or protocols for protection of personnel at their institutions. Not talking about violence with colleagues and patients is a common form of self-protection as there is a great degree of mistrust of colleagues and patients.

Conclusions and Implications: Findings highlight the high risk work environments where health professionals must serve. Health professionals in rural locations are vulnerable to victimization and are left largely unprotected. Personnel in hospitals report having to work in extremely stressful and volatile circumstances. The threat of violence and violence in or near the workplace is a source anxiety, paranoia and fear. Resources for health professionals to seek support for mental health problems are non-existent. This study underscores the importance of understanding how violence affects health professionals. Preventive efforts are needed to protect service providers that may be applicable in other contexts or geographic regions.