Who’s On the Stairs?

If you are visiting a client in an apartment building, you should never, ever just walk up to the door and knock.  Always listen at the door first to see what it is that you are walking into.

Always check the hallway exits outside the client’s apartment. Make sure that those exit doors are not concealing an unwelcome surprise.  The last thing that you want to deal with if you have to leave in a hurry is hostile intoxicated people (who may be friends of the client) on the stairwell landings.  If you have to leave in a hurry, you certainly aren’t going to be waiting for an elevator:  You’re going to be heading for the stairs.  You want to make sure that exit door is unlocked in case you need to use it to escape quickly.

I remember a case that we dealt with where the police had made several visits to an apartment to investigate domestic disputes during the course of an afternoon. Twice an intoxicated male had fled from the building when police arrived. When we came on duty we were asked by the officers involved to check this apartment, where a known client with a child was residing. Everything seemed quiet when we arrived at the client’s door in the hallway. But out of habit we checked the exit door only six feet away to see that the exit stairs were clear before we knocked on the client’s door.

They weren’t. A snarling German Shepherd attacked me as I opened the door. The client’s intoxicated boy friend had positioned himself on the exit stairs with a case of beer and his dog with the intent of setting the dog on the client if she left her apartment. Fortunately this male had passed out, so he had not let the dog out when we first arrived at the client’s door. I was able to slam the door on the dog and request assistance to remove both the dog and the male.

Charles

Who’s Calling?

If there is any chance that somebody in the residence that you are going to visit speaks a language that you do not understand, it is prudent to have an interpreter along to assist. This may not seem necessary if the client speaks your language, but in times of stress and crisis, persons often resort to their language of origin. As well, the client who seems helpful and cooperative could pass instructions to another party in a language you don’t understand that may compromise your safety without you being aware of it. I recall an incident involving a pair of workers who attended at a residence to apprehend an Asian child from the child’s grandmother’s residence. When the workers arrived, the grandmother presented as cooperative and friendly. She excused herself to conduct a telephone conversation in a foreign language. She did this within sight and hearing of the workers, but as they did not speak the grandmother’s language they did not realize that what she was really doing was phoning the child’s father, a gang member, advising him to intervene. Just as the workers were getting into their car with the child several car loads of gang members armed with baseball bats pulled up. The workers were boxed in and the gang members smashed out the windows of their car. Fortunately the workers had a cellular phone and called 911. As luck would have it, they were only a few blocks from the police station and there were police units available there.  Police arrived quickly and arrested these parties just as they were climbing in the windows of the worker’s car. Fortunately these workers escaped without injury, but they were traumatized for weeks afterwards. 

If these workers had thought to take an interpreter with them in the first place, they may have escaped without incident. I recall another incident in which a client was overheard by a court interpreter. The client was threatening to “wait outside and do something to that worker.” The worker was able to notify the court sheriffs to deal with this situation.

Charles Ennis

Dealing With Stalkers

Linda, the creator of the Fried Social Worker Blog wrote to me asking:  “Do you have any suggestions for social workers who are concerned about clients stalking them? A few days ago a colleague was telling me of her experience of being stalked by an ex-client. I started searching the web for good resources and most of the stuff out there is for victims of domestic violence, not the practitioners who work with them. It occurs to me that in the increased dialogue about social worker safety these days, stalking is an issue that’s not being addressed.”

 

I know that this is a major issue for a lot of people.  It will be no surprise to social workers that according to the Stalking Resource Center, more than one million women and 400,000 men are stalked annually in the US.  The average length of stalking is 1.3 years, although most situations last about a month. 

 

First of all, treat all stalking as a serious and legitimate threat. Involve the police and your employer right away so that they can support you.  Get the police to attach a premise history to your home and work address.  Modern CAD (Computer Assisted Dispatch) systems automatically display hazards and histories of addresses to call takers and dispatchers:  this means that if you call in and can’t say anything, the CAD will automatically list the history attached to your address.  This allows the call taker and the dispatcher to instantly see that it is you calling and that you’re having a problem with a stalker, listing his/her particulars and the address history.  This will help them to respond swiftly and appropriately even if you are unable to tell them what is happening.

 

Ensure your home phone number is unlisted with your local phone provider.  Program 911 on your cell phone to speed up emergency response.  Remember when calling 911 to always give your address first.  That way, if the police dispatcher knows nothing else, at least they will know where to send their police units.  Unlike land lines, cellular phone calls do not reveal your exact location to the police dispatcher.  All that the call taker and dispatcher sees on their screen is a display showing the location of the repeater tower the signal is coming in to and the azimuth that it is coming from.  In the US, cellular phone providers are now including a GPS locator in cell phones that helps the police narrow down your location, even if it doesn’t provide your exact location.  If you are using VOIP as a phone provider, be aware that the address that is displayed to the police dispatch is always your home phone location.  If you are using VOIP to call 911 from anywhere else you need to either temporarily reprogram the location or make sure that you tell the 911 operator where you really are.  Otherwise the police will be responding to your home address even if that isn’t where you actually are.

 

When you find yourself plunged into a crisis situation, you will fall back on whatever you have planned and/or rehearsed.  If you don’t plan for contingencies, then when things suddenly get ugly you may fall into a basic “deer in the headlights” response that isn’t a safe or effective response to the situation.  Developing safety and escape plans will help you to overcome this.  Develop and implement a safety plan which outlines to your friends and employer what you plan to do if you have to leave your home in an emergency.  Plan escape routes from your home and office and rehearse them.  Select safe destinations that you can use in emergency situations and have more than one.  Advise your friends and employer where these safe havens are located.  This will help you stay in control during an escape. 

 

Put together a “ready bag” at home packed with all of your important documents (driver’s license and registration, birth certificates, social security/SIN cards, insurance papers, extra cash, address book, prescription medications, spare clothing, cell phone, etc).  Keep it hidden in a place where you can access it quickly.  You could also leave extra money, spare keys and copies of important documents at your safe havens with people that you trust.

 

Give your co-workers, friends and family a “code word” that you can use to let them know that you need immediate assistance.  Sometimes it is difficult to talk openly on the phone in front of the abuser and you’ll want a way to tell them you’re in trouble without tipping off the stalker who is listening.  A code that my social worker and nursing partners used in the field to indicate to me and one another that we had spotted a hazard and were preparing to escape/respond was to start referring to one another by our surnames instead of our given names as we usually did.  This isn’t obvious to listening suspects and could be a useful clue to your office worker, friend or family member on the other end of the phone that you need the police immediately.

 

When you leave the office, make sure that they know where you are going and when you expect to return.  Tell them your estimated time of arrival and expected route.  Your office should have a display board on which this information can be recorded so that your movements can be monitored and a person responsible for monitoring it.  That way if you do not show up or return on time, someone can start checking up on you.  Make sure that your vehicle doors are locked at all times.  Always check in and around your vehicle before entering it.  Always check around the parking area before committing to a parking space.  Avoid walking alone, especially at night or in isolated areas.  Get police back up to cover you at problem locations.  This will help to discourage possible threats lurking in the area when you arrive.  It will also allow them to cover your departure, making sure that no one attempts to follow you.  They can also escort you to and from the place that you are visiting and escort your vehicle if necessary.

 

If you become aware of someone following you, immediately call for police assistance with your cellular phone.  Pass on the vehicle license number, description, number of persons visible in the suspect vehicle and your location and direction of travel.  Stay on well lighted and well traveled roadways and avoid stopping if you can.  Head for a place such as a police station or public building where security personnel can see you and assist you (these locations should be part of your escape route planning).  Flash your headlights and honk your horn to attract attention if necessary.

 

Maintain a journal detailing all incidents of stalking.  Include dates, times, locations and a complete description of the stalker.  Detail all that was said and the actions that you took.  List all witnesses.  You should get an answering machine at home that will not only allow you to screen incoming calls (and often identify the caller) but will also record threats made over the phone.  Use the telephone provider’s ID function (such as *57) to identify the phone number that the stalker is calling from and note this down.  Get your local phone provider to help you track the origin of unsolicited calls:  Usually they can set up a “trap line” to capture this information.  This will all be useful evidence for the police in court.

 

Get a protection order.  These vary from jurisdiction to jurisdiction and can be criminal or civil, temporary or permanent.  In most jurisdictions violation of such orders results in arrest and jail time and/or fines.  Even if the order is civil, most jurisdictions treat violations as a criminal matter leading to prosecution and incarceration.

 

In my book, The Safe Approach, I have included comprehensive safety tips and suggestions, as well as hold release techniques, when it becomes necessary to escape from a violent assailant.  In addition, the following websites contain comprehensive statistics and resources about this problem:

 

Stalking Resource Center

Network for Surviving Stalking 

AWARE (Arming Women Against Rape and Endangerment) 

AARDVARC (An Abuse, Rape and Domestic Violence Aid and Resource Collection)  

 

Charles Ennis

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

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

 

 

 

Planning and Preparation

A situation that I’ve seen play out time and again in the field is where the social worker or nurse does the right thing and requests police back up.  The police arrive, the social worker and police basically introduce themselves and then everyone troops into the house.  No one stops to explain the purpose of the visit to one another.  No one explains what his or her expectations are.  No one discusses the history of the family or contingency plans should things suddenly go “pear shaped”.

Far too often when things do get violent, social workers find themselves in the line of fire.  Having the police backup there helps, but if the visit is planned properly then it is the police who deal with the violence (which is their mandate) and the social worker escapes unscathed.  I remember one case in particular from my experience at Vancouver PD, where the first thing that the police officer in the home thought of when things got violent was the safety of the child:  he picked up the child and ran out of the house.  Unfortunately this left and unarmed social worker facing an irate parent.  This shouldn’t have happened.  It should have been the social worker leaving with the child and the cop making sure that happened.

I was reminded of the potential for violence in such situations when reviewing a case from Washington state back in 2005, where a Department of Social and Health Services social worker was attacked by a male with a machete and a club (for details see memo from Anna Kim-Williams of the Governor’s Communication Office, “Attack of Child Protection Services Worker”).

Time taken to discuss and plan before entering a risky situation is always time well spent.  When things get violent you will instinctively fall back on whatever you have planned or rehearsed beforehand.  If you have done neither, then you’re going to be standing there like a deer in the headlights, and that’s not a good survival response.

Charles Ennis

 

 

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.