A surprising (and growing) gender gap in the most dangerous jobs

This database of workplace injuries is incredibly detailed, offering a concise but wide-ranging portrait of tragedy and mishap in the American workplace. It tells us how often workers are strangled by another person and how often they are caught in running machinery. It dutifully logs injuries caused by horseplay (which, the government helpfully notes, includes “roughhousing”) and walking (without other incident), alongside injuries to people who accidentally Taser themselves (a risk presumably encountered by a limited subset of workers).

When we dove into the database, which is powered by an annual survey of 230,000 employers conducted 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 distressed we became. The drop in workplace injuries occurred primarily in the largest categories: Overexertion injuries including those caused by heavy lifting. Repetitive-stress injuries. Slips and falls. Contact injuries, which typically involve getting hit by something, like a piece of equipment.

Another major category, injuries caused by people or animals, remained flat. Or at least that’s how it first appeared. In fact, that flat line concealed two diverging trends: A sharp decline in people accidentally injuring each other. And a huge increase in injuries caused by intentional workplace attacks.

The number of intentional human-caused injuries just keeps rising. Every year, more and more Americans are hit, kicked, beaten or shoved so badly that the victim misses at least a day of work. (The number of injuries fell in 2020 when many of us were social distancing and working from home, but the broader trend is ominous.)

To understand who is being attacked, we analyzed the largest category — hitting, kicking, beating, shoving — by gender. The gap was alarming. Not only are women far more likely to be attacked and injured so badly that they miss work, but almost all the past decade’s increase in hitting, kicking, beating and shoving in the workplace has been targeted at women.

What is going on? On deeper examination, we discovered that only a handful of major occupational groups are at real danger of being attacked by other people at work: education and health-care workers, and a broad group of service workers that includes everything from home health aides to cooks.

But which of those jobs drove the increase?

Based on total injury rate, the most dangerous job is athlete, a fact not lost on the fans and gamblers who eagerly await the latest sports-injury reports. But athletes aren’t getting 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 top cause of injury is revealing. Those 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 disability, often in psychiatric hospitals. It’s 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 often are the ones that are the punching bags for the [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’re there just to treat these patients.

“So what they end up seeing are horrific, horrific things. And what they end up suffering are incredibly horrific events,” Pizzotti said. “We have many psych techs that have been beaten so badly that they can’t return to work.”

As it turns out, about 4 in 5 psychiatric techs are women. We’re used to seeing lists of the most fatal jobs, which are dominated by largely male professions such as fishing, logging and roofing. But a job can be exceedingly dangerous without being fatal. And when we judge dangerous jobs by injuries rather than deaths, jobs dominated by women rise to the top.

That fact comes into startling view when we chart the jobs where the number of injuries caused by violent attacks is rising. Teaching assistants, personal care aides, psychiatric aides and techs, elementary teachers and registered nurses top the list. Every last one of those occupations is done mostly by women.

Meanwhile, the jobs with the largest decrease in attacks — police officers, correctional officers and police supervisors — are all performed largely by men.

But why the rise? We started with education workers. Research on school violence used to focus primarily 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 risen. It takes experience and training to defuse violent 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 turnover among teachers’ aides soared between 2010, when the typical assistant had been on the job 5.6 years, and 2020, when the typical aide stuck around for just 3.2 years.

“There’s definitely a connection between violence and victimization and teacher turnover,” McMahon said.

Next we turned to psychiatric aides and technicians, the folks who most frequently face being grabbed, scratched, bitten, choked, punched, kicked, shoved and spit on at work. There’s no smoking gun that explains why their work has grown increasingly dangerous, said Jack Rozel, a professor of psychiatry at the University of Pittsburgh who leads meetings and trainings about workplace violence in psychiatric hospitals, in addition to treating patients enduring mental health crises.

But Rozel did note one critical source of trouble with those jobs: The skills needed to deal with high-risk patients are developed only through training, experience and mentorship. But the riskiest patient-facing jobs are low-paid, entry-level positions that do not inspire workers to stick around long enough to learn them.

“It’s technically demanding, emotionally challenging work. It takes time to get good at it,” Rozel told us. “The challenge is finding a way to learn how to manage someone who’s 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 who live 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 rises when they fall through holes in the fraying social safety net and are allowed to get sicker and sicker before they reach the hospital.

Elizabeth Sinclair Hancq directs research at the Treatment Advocacy Center, a nonprofit that works to improve care for those with severe mental health issues. She says that as the nation’s capacity to treat the severely mentally ill has declined, particularly at state-run facilities, it has become harder for people to access care.

Many patients enter a treatment facility only when their symptoms have become so serious that they present a danger to themselves or others. To that point: A growing share of state mental hospital patients are connected to the criminal justice system, either because they are awaiting trial or have been deemed not guilty by reason of insanity, Hancq’s research shows.

“As psychiatric beds decline, the ability to access beds also declines,” Hancq told us. “So patients that are ultimately being hospitalized in an inpatient unit have higher levels of acuity — higher levels of more severe symptoms — which is known to also correlate with increased attacks and violent and aggressive behaviors.”

Future data releases on workplace injuries may paint an even darker picture. During the pandemic, patients have been cooped up, dangerous behavior has risen across the board and psychiatric beds were further limited to make room for covid patients.

The nation also is experiencing massive shortages in the number of workers willing to do such dangerous and traumatic work — most of them women.

Howdy! The Department of Data turns quantifiable questions into columns! What are you curious about: Who shows up most on White House visitor logs? Do they still use as many 555 phone numbers in movies? Which American city has the narrowest downtown streets? Just ask!

If your question inspires a column, we’ll send an official Department of Data button and ID card. This week’s buttons go to Mike Morde in Rochester, N.Y., who asked about psychiatric hospital capacity, and to Sydney Sonneville in Chicago, who sent us data from Definitive Healthcare on the hundreds of thousands of health-care workers who have dropped out of the workforce.