Check the History and Take Cover

How many of you have been faced with this task: trying to get a decompensating mental patient to return to treatment?  It is a task that I am very familiar with, having spent many years as a police officer working in the Mental Health Emergency Services unit of the Vancouver PD.  Many of these clients were resistant to such efforts, since they had no insight into their condition, were paranoid, and often were self- medicating with street drugs.  One of the things that motivated me to write The Safe Approach was to help social workers and nurses to deal with this sort of scenario.

I was reminded of all this when I reviewed an older article from the UK’s The Independent newspaper, “Frenzied Attack on Social Worker“.  This told of dedicated social worker, Jenny Morrison, 50, who went alone to try to convince Anthony Joseph, a schizophrenic male, that he needed to return to psychiatric hospital.  This schizophrenic killed her, stabbing her more than 100 times, breaking the first knife and calmly walking back to the kitchen in the halfway hostel to get another to continue the attack.

Apparently Morrison had gone there alone, and although some other workers had arranged to be there to cover her, they had not shown up.  This demonstrates the paramount importance of taking adequate resources to cover the situation that you expect to face upon arrival.  Going alone to see an unstable and possibly violent client is never a good idea.  Having fellow workers accompany you is better, but in such situations it is always best to have the police with you.

Another incident which underscores the hazards of going to dangerous dwellings alone, is the case of a West Virginia social worker who was murdered when she conducted a solitary home visit, as reported in Tony Rutherford’s article “Social Worker Attacked, Sexually Assaulted, Murdered, Burned”.

Checking collaterals is another issue I covered in The Safe Approach. Before attending to see the client, you need to check any and all sources of information to get as clear an idea as possible of the risks that you are likely to face. The author of the Independent article, Terri Judd, reports “Mr Joseph had not picked up his medical prescription for five months and had told fellow residents at the social services hostel that he was selling his pills to “clubbers”, while taking a cocktail of heroin, crack cocaine and ecstasy himself. Three weeks before the attack, care staff were well aware that he had stopped taking his medication, yet he remained free to come and go as he pleased, the court heard.” The staff had specifically asked for assistance, because Joseph’s behavior had deteriorated dramatically since his release from the psychiatric hospital. He was described as abusive, as having paranoid delusions about being pursued by fascists, as being “tortured by dark spirits”. Joseph made no secret of the fact that he did not believe he was mentally ill and that if returned to the psychiatric hospital, he would be tortured. All of these behaviors are ‘red flags’ that should have led to the police being brought along to the scene for back up.

Usually safety problems result from a combination of factors. Training may fail to accurately reflect reality. Perceptions of the true risk may not match the actual risks involved. A study by Carmel and Hunter in 1990 found that frequent training can improve the likelihood of avoiding assault.

Yet workers may receive no training in safety considerations at all (*). More often than not they are expected to pick up whatever they need to know on the job. Workers become complacent in the knowledge that most people in the profession reach retirement without ever being in a potentially dangerous position. Day in and day out, workers investigate situations where nothing happens and complacency sets in. They may approach a situation casually, hastily, and with over-confidence, as “nothing ever happened before”. They begin to assume that “nothing ever will happen”. And then it does.

Charles Ennis 

(*) US Dept. of Labor, Occupational Safety & Health Administration; (1996) Guidelines for Preventing Workplace Violence for Health Care & Social Workers OSHA 3148-1996. pg 9.