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Preventing Violence
The department is particularly keen that trainees should not place themselves or others in
jeopardy.
We support additional study leave to participate in Breakaway Courses.
A vital part of violence management is an accurate appraisal of the client, the situation,
interview and resources. The University of Liverpool recommends the the WHO
guidelines for its students on preventing
violence and safety.
Client Information Prior to Seeing
Ascertain if there is a past history of violence in what situation, whether there is a
history of drug or alcohol abuse, or brain damage, and what relationship there is to
behaviour on previous occasions.
Is the patient displaying signs of agitation or fear?
Record all behaviour prior to violence or potential violence to warn others and possibly
help the client recognise the signs and control themselves in future.
Situation at Interview
Know the layout of the area, escape routes and alarm bells.
Be aware of potential danger areas wherever you are and the need for social space.
The Interview
Keep calm, don’t show fear or anxiety.
Keep between patient and door, leave the door open if necessary.
Possibly have another person there.
Stay out of reach, don’t turn your back.
If you need help call as unobtrusively as possible.
Observe patient’s behaviour-tense, agitated, overactive, speech-rate and content.
It may be better to have more short interviews than one long one.
Avoid confrontational postures or style
Flight is better than fight
Resources
Make sure people know where you are, and are available should you need help.
Be on good terms with colleagues and the police.
See people with a colleague when advisable.
Try to see people in your own office. Ensure the safest layout of interview rooms is used.
Pre-plan the situation and share that plan with a colleague
Be aware of yourself, recognise your own moods, prejudices, provocativeness, ability to
control your voice, fear, anxiety and interviewing skills.
Do not be afraid to share your a concern and ask for help or advice. Always seek help in
discussing serious incidents.
Provide help for those who have been involved in incidents and learn from experience.
Document and report incidents.
Doctors who visit patients in the community
1. Record -
where you are going
when you are going
when you expect to be back
2. Ensure someone knows the above and can check you have returned.
3. Each doctor should be aware of the possible risks and not place themselves in any
potentially dangerous situations.
4. Give serious consideration to going on joint community visits. Be mindful of your own
safety and that of others. If you have concerns about visits discuss these with your
supervisor. Give consideration to enlisting police help, using alarms and/or portable
phones.
VERBAL THREATS/AGGRESSIVE INCIDENTS TOWARDS MEMBERS OF STAFF
This policy aims to cover incidents, particularly of aggressive verbal abuse which may
include threats to kill or injure either in a face to face confrontation, or over the
telephone. In addition, threats of a more direct physical nature towards staff should also
be covered by this Policy.
As each incident/situation obviously has to be dealt with on its own merits and the given
circumstances at the time, the following guidance must apply.
Verbal Abuse
Members of staff who receive the abuse, either through face to face confrontation or over
the telephone should immediately inform.
the patient's Consultant, or if not available the Duty Consultant
Senior Nurse on duty within the Unit/Premises
the patients key worker, if available.
The patients Consultant/Duty Consultant should then discuss with the Senior nurse/Key
worker the circumstances of the situation and determine, on clinical grounds, the most
appropriate course of action.
In relation to threats to kill, then in all occasions these need to be reported to the
Police and this should be done by the person who initially receives the threat. The RMO
may also need to speak to the Police to convey a clinical view of the likely risk factors
associated with the threat i.e. The likelihood of the threat being carried out.
Policy for procedure when threats are made against staff
Confidentiality Issues
When the patient threatens violence, our duty of confidentiality must be balanced against
the risk he/she poses to others. Thus the need to maintain confidentiality must be weighed
against the seriousness of the threat.
When ever possible, the consent of the patient should be sought before anyone outside the
Clinical Team, is informed ( including the Police recipient of the threat ). If consent is
unobtainable, unless it would put the informant at risk the patient should be told that
confidentiality will be broken and to whom the information will be passed.
Whilst discussing the patient with persons outside the Clinical Team, sufficient detail
should be included to enable them to assess the risk and take appropriate action. Thus
details of : relevant threats and past behaviour, previous threats, assaults or
destruction of property, attitude to object of threats, presence of serious mental illness
etc. may be included. However, care should be taken not to reveal confidential clinical
material which is not strictly relevant to assessment of the immediate risk.
In the event of a threat of physical violence
The staff member receiving it should report it to the senior Nurse on call and the RMO or
Duty Consultant if the RMO is unavailable.
The Senior Nurse and the RMO/Duty Consultant should discuss patients.
A variety of actions may be necessary. They include:
Informing the police. (see criteria below)
Informing the person against whom the threat has been made.
Assessment of the patient's mental state, with a view to admission.
Contacting the Social Services with a view to assessment under the Mental Health Act.
Discussing the appropriate action with ward or reception staff, if the patient is on the
unit or might attempt to visit the unit.
If a threat is made against staff in one of the care teams, the it may be appropriate to
discuss it with the team Leaders.
Criteria for informing Police
Threats assessed as serious (see below)
If threats assessed as ambiguous or of marginal seriousness, this must be balanced against
possible adverse effects on patient of informing police, and against the need to retain
confidentiality.
Criteria for assessing dangerousness / seriousness of threats
Previous violence against property or persons.
Previous attempts to carry out threats.
Threats stemming from delusional ideas.
Evidence of sociopathic personality traits.
Repeated/consistent threats especially with evidence of planning or premeditation.
Direct Physical Assaults/ very Aggressive Behaviour
It is important to seek assistance from other member of staff by shouting or using the
personal alarm system. Staff should not try to tackle incidents without help.
The Senior Nurse on duty must be contacted as soon as possible in order to co-ordinate
appropriate action.
The Senior Nurse should then always contact the patient's Consultant or Duty Consultant to
discuss management of the situation and aspects of its aftermath and agree a plan of
action.
The effect of the management plan should be subsequently audited.
In dangerous incidents e.g. assaults involving offensive weapons, the Police should always
be called.
Recording of Incidents
The Incident should be reported by the person receiving the threat to the manager of the
Psychiatry Services, who will keep a list of incidents, which will be reviewed quarterly
by the Mental Health Management Group.
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Version 4.0
October 2000