Document for Safety

I was reading an article “Remember Those Who Died in Social Care” on the Social Work Blog talking about social workers who had died in the line of duty.  Mike Broad, the author of this entry, said that:

“…Progressive employers are investing in training that encourages their staff to stay calm and confident, read the signs of agitation and have clear exit strategies.  They ensure that detailed records on clients are kept and shared, and risks assessed.  All incidents are reviewed and approaches planned.  Staff have access to technology such as alarms and monitoring systems.”

I couldn’t agree with this more.  Broad reported that the British government took this start in 2001 with a £2 million campaign intended to reduce violence against social workers by 25% by 2005.  Unfortunately 2005 arrived and the government had no idea whether this campaign had worked because the “detailed records” that they’d called for had never been centralized. 

One of the key pieces to the safety puzzle is reviewing all pertinent information on a client.  Workers and police that fail to document past history thoroughly are putting future workers on the case at risk.  All workers in the country should have access to everyone’s records:  Clients with histories of neglect and abuse often move around to avoid the consequences of their actions.  It’s not going to help a worker in one region if they can’t see the client’s records from another region.

Charles Ennis

Workers Want Safety Training

In “Is Social Care Work Safe?” I was reading the comments of fellow social care workers responding to the death of Philip Ellison:

Lins:  “When is something going to be done to protect workers?  In Children Services we are told not to go out alone if there is a potential for violence, but how many times, due to staff shortages, have we taken the chance?  If it was a police officer would they go out alone?”

Well said Lins.  As a former cop I would most certainly confirm that we wouldn’t go to a violent situation alone.

Anne:  “Managing conflict is essential training for any isolated worker.  As is appropriate lone working policies and procedures.  The real danger is when a violent/aggressive incident arises out of the blue.”

As they too often do.  Which is why we ought not to be having social workers out there alone if it can be helped.  The real danger is always there, even if it only seems to be coming “out of the blue”.  The fact is it rarely does.  Too often the clues are there to warn us but we don’t attend to them.

Preeta:  “The people who you see on doubled up visits have usually done or said something to warrant joint visits, it is sometimes impossible to gauge that you are walking into a high risk situation if you have had no warning that a service user is relapsing (for example).”

Most of the time there is a clue to warn you.  Safety awareness is an ongoing reassessment of your situation.  Safety is about 75 % attitude, 15 % skill, 5 % physical, and only 5 % luck.

Brian:  “It is long past the time for society to acknowledge that those of us who work in the social care profession have the right to go about our duties without the fear of abuse and assault.”

I totally agree with Brian’s assessment.  I came to that conclusion eleven years ago and went on to try to do something about safety for my colleagues in the helping professions.

A study cited in Brody’s article support’s Brian’s view.  This study, which estimated that 50,000 social care staff are attacked in Britain each year, showed that two thirds of social workers wanted some sort of self defence training.  There is certainly nothing wrong with this approach, but it requires an enormous investment in time and money to make a large group of social workers competent enough in self defence that they can rely upon this skill.  You can’t become a martial artist in a weekend workshop.  I point this out in the hold-release section of my book The Safe Approach.  Brody admits that he once argued that “self-defence training could do more harm than good, if it increased confidence without developing skills to a level where they would be useful in real life.”  There you go.  However most of the safety problem can be dealt with by recognizing the escalating situation and getting out before it turns to violence.  Basic principle from Sun Tzu’s The Art of War:  The best general is the one who wins without fighing.

Charles Ennis

Dealing Safely With Emotionally Disturbed People

I spent many years in the Mental Health Emergency Services unit of VPD getting mentally ill people safely to treatment facilities. For nine years I managed to do this without ever harming a client, at the same time always keeping the nurses and social workers that I worked with out of harm’s way. Now I’d like to share some of my experience with social workers and nurses to keep them safe in the field.

Before you leave the office, always start by reviewing all available collateral information on the person you intend to assess. This should include police history (criminal record, call history) as well as mental health/hospital records (history of treatment, behaviour when ill). Try to identify patterns and “baseline” behaviour. Do they have common delusions such as the idea that someone is projecting energy/radio waves into them? Maybe they’re paranoid? Look for precautions that they may have taken to “protect” themselves from these perceived threats. Those countermeasures may constitute a threat to your safety.

Always be looking for obvious signs of use of prescription or non-prescription drugs, as well as the use of alcohol or street drugs.  Many mentally ill people attempt to self medicate.  Many psychiatric meds should not be mixed with alcohol consumption.  Many of these attempts to self medicate only exacerbate their illness.  If you can, get the person to show you their meds.  This will give you an idea what it is they are taking, as well as how much.  If the label on the bottle containing a month’s supply of pills is dated the beginning of the month and it is now the end of the month with the bottle nearly full, it is a clear indication that they aren’t compliant with their medications.  The label on the medications also will give you an idea who the GP or psychiatrist of record is.

If the client admits that they’ve discontinued meds, try to find out why.  Many medications have side effects which cause the patient to give up on them, such as drowsiness or weight gain.  Ask if they’ve had allergic reactions. Often they’ll give you accurate information on allergies.  Many patients with a history of non-compliance will respond to my question about allergies by listing every psychiatric medication they’ve ever been prescribed.  This is a pretty clear indication that they aren’t going to cooperate with the medical plan without supervision.

Many emotionally disturbed people can pull it together for a short time in an attempt to cover their illness and avoid apprehension.  A little patience and persistence can often pay off as most of them cannot maintain this front for long.  It is a bit like asking them not to blink.  Sooner or later it will out.

I’ve always found it useful to ride in the ambulance and/or continue the assessment at the hospital.  Typically as soon as the client realizes that “the game is up”, they will drop their guard and let out all kinds of useful information and behaviours.  All this information should be carefully documented to assist people trying to follow up later.

Be direct.  Ask the client up front if they are suicidal, or having thoughts of harming themselves or others.  It is amazing how many social workers and police officers find this question so difficult to ask.  Remember, you’re there to help them and this information is vital. Ask them if the client feels safe.  Do they feel a need to protect themselves?  If so, what measures have they taken to protect themselves?  This will give you an idea if they are paranoid and, if so, how severe the paranoia is.  It also alerts you to dangerous behaviours and situations to guard against.

Ask if the client hears voices.  If so, are these “voices” telling the client to do certain things (command hallucinations)?  Does the client believe that they are getting messages from the TV, radio, or newspaper?  Ask if the client believes that they can read your thoughts and/or if they think that you can read theirs.  Watch for blocking behaviour and/or latency of response.  If they take their time responding to you, they may be responding to internal stimuli.  Do they appear to be looking at things or responding to stimuli no one else perceives? 

Safety is an ongoing reassessment of your surroundings and the persons that you are in contact with.  If you pay attention to the things I’ve listed here, you’ll be in good shape to keep yourself and your client safe.

 

Charles Ennis

 

Det. Ennis assisting an EDP in the Downtown East Side of Vancouver

Det. Ennis assisting an EDP in the Downtown East Side of Vancouver