Seven Actions to Ensure Safety in Psychiatric Office Settings

Workplace violence can happen in any setting. The Centers for Disease Control and Prevention (CDC) defines workplace violence as “the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty.”

The possibility of being verbally or physically assaulted, stalked, or threatened by a patient is not only a concern but reality for psychiatrists, especially those with limited resources and lack of on-site security. The following actions are recommended to improve safety and security in psychiatric offices and should be tailored to each individual practice.

1. Workplace violence assessment, response, and prevention plan

   • Conduct a workplace violence assessment and create a workplace violence prevention and response plan regardless of the size or location of your practice.

   • Assess for workplace hazards within and around the office and plan for the various types of violence that may occur, whether physical violence against staff or verbal violence/harassment/bullying.

   • Be sure to include, as appropriate, representatives from each discipline in your office.

   • If you sublet space, include the practitioners who use that space.

   • Consider involving law enforcement and risk management in your planning.

   • Review the plan with staff at least annually.

2. Office and physical safety

   • Control/restrict access to the office by patients, visitors, and contractors by providing individual access card readers and/or locks to staff only or limiting access to restricted areas.

   • Ensure patients, visitors, and contractors are escorted within the office and do not wander alone.

   • Install video surveillance cameras at entrances and exits and post signs indicating their presence as a deterrent to violence.

   • Employ an office “buddy” system—no one works alone, including afterhours, or goes to his or her car alone.

3. Social media: your patients are not your friends

   • Don’t accept “friend” invitations from your patients on social media, and do not look up your patients on social media (consider boundary issues and privacy).

   • Be mindful of posting personal information about yourself, family, and friends that may reveal your habits.

4. Be aware of stalking behavior and boundary crossing

   • Be aware of behaviors that are unwanted or distressing including threatening, harassing, and stalking behaviors.

   • Develop policies and procedures to identify, communicate, document, and track concerning behaviors, boundary violations, boundary crossings, and patient stalking.

     • For each occurrence of workplace violence/behavior incidents, document it and discussions about behavior expectations in the patient’s medical record.

     • Communicate concerning behavior to other multidisciplinary staff members.

     • Seek assistance from your risk manager, legal counsel, and security/law enforcement.

5. Communicate concerns and plan an escape route

   • Avoid having your back to the exit, and turn your body sideways to allow a clear path to the exit if a quick escape is necessary.

   • Install panic buttons in each office, at the reception desk, and in bathrooms.

   • Wear an audible alarm.

   • Designate a safe room within the office should an escape not be possible.

6. Call 911 if you fear for your safety or the safety of others

   • There is a HIPAA exception for disclosure to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public. When disclosing the threat, limit the disclosure to nonclinical information.

   • Terminate patients that display violent/aggressive/stalking behavior toward you or your staff and consider whether a restraining order/noncontact order is needed. (See “Risk Management Considerations When Terminating With Patients,” which is posted here.)

7. Education and Training

   • Provide clinical and nonclinical staff interactive, site-specific education and training.

   • Educate staff about the nonverbal cues of aggression, agitation, and behavior escalation that may lead to an assault.

   • Provide de-escalation and response training.

   • Consider self-defense/personal safety training. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings Ltd., a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.