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Professional News
How to Stay Safe in Your Office
Psychiatric News
Volume 41 Number 19 page 7-7

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.”

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  • 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.

    • +
  • 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.

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