Psychiatr News October 6, 2006
Volume 41, Number 19, page 7
© 2006 American Psychiatric Association
How to Stay Safe in Your Office
Many psychiatrists practice with the possibility of encountering patients
who are violent. However, clinicians can take steps to reduce the risk of
harm.
- Obtain a thorough history, including history of violence or interaction
with law enforcement, to help identify potentially violent patients and use a
standardized risk assessment tool, such as the MacArthur Community Violence
Interview used in NIMH's CATIE study.
- Be aware that previous violence and/or substance abuse are the most
significant predictors of future violence.
- Share your assessment of patients' risk of violence with them. Ask patients
to estimate their risk of violence and discuss the issue fully.
- Foster impulse control through setting strong limits on patient behavior
and offer acceptable alternatives to inappropriate behaviors.
- In private offices in homes or office buildings, foster a more secure
physical environment:
- Remove objects that could become weapons.
- Install office doors with windows to allow monitoring of sessions.
- Ensure more than one escape route from your office.
- Install a panic button to summon help.
- Never see patients who have a history of violence or paranoia or who are
borderline with little impulse control in a home-office setting or in a
private office suite when no support staff are immediately available. A more
secure setting is indicated, such as a hospital ER or a community mental
health clinic that has security staff.
- When confronted with an imminent threat of violence, use clinical skills to
de-escalate the situation.
- If you are physically attacked by a patient who has no weapon and are
unable to escape or summon support/security staff immediately, a good strategy
is to "clinch" or employ the "bear hug."
- If attacked, you must actively defend yourself; under these circumstances,
self-defense must take priority over Hippocrates' admonition to "first,
do no harm."
Adapted from Carl Bell, M.D., "Psychiatric Aspects of Violence:
Issues in Prevention and Treatment," New Directions in Mental Health
Services, summer 2000.
Related Article:
-
Patient Charged With Murder Of Schizophrenia Expert
- Jim Rosack
Psychiatr News 2006 41: 1-7.
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