Guns and safety concerns in our offices

[psyman]

Regarding this story:

http://www.nytimes.com/2014/07/25/us/caseworker-shot-dead-by-patient-police-say.html?_r=0

I've been meaning to start this thread for a while and would like to hear opinions. One thing we all have to say is true, had he not had and used that gun, he and more people would be dead. I've definitely worked in settings I KNOW were not safe and think about "what if" situations a lot. Often just having more staff would have helped immensely.

Any thoughts? And specifically, what is your reaction to the actions of this psychiatrist?

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[Therapist4Chnge]

I'm glad the psychiatrist was able to defend himself, though it is unfortunate that violence was needed to stop the imminent threat. I believe I read the patient had 40-50 additional rounds on his person, which suggests it could have been much much worse. Unfortunately most/all hospitals that I am aware of prohibit guns on their properties, even if the person has a CCW…so the psychiatrist had to violate hospital policy to protect himself and the lives of the other people in his clinic. If someone is dealing with high risk populations, either proper security needs to be utilized (including an armed guard in the clinic, not just "on the property somewhere") or the workers should be allowed to carry if they have the proper training and licensing. I doubt this will ever happen, so the workers are left to fend for themselves and hope they aren't shot/stabbed/etc. while at work. I personally would not work in a setting with high risk populations if I didn't have an armed guard or be allowed to carry on my person.

 

[QAsPsych]

One thing we all have to say is true, had he not had and used that gun, he and more people would be dead.

No, we don't know that, it is literally impossible to know. I think better security is clearly needed in that environment, however.

 

[G Costanza]

No, we don't know that, it is literally impossible to know. I think better security is clearly needed in that environment, however.

We can assume given the variables that the mostly likely scenario is that he intended to kill the doctor and perhaps others but was stopped because of someone with a concealed firearm. The local police chief in PA seems to agree.

I know a lot of MH professionals that do carry and a few that would if it didn't put their job at risk.

 

[PsyDr]

Defense and impression management are key in forensics.

If the clinician does not engage transference in a manner that is beneficial, then the clinician risks everything.

If the clinician does not create an area that is safe, everything is risked.

Says the guy who lives in a veritable fortress with 3 other expert witnesses.

 

[psyman]

No, we don't know that, it is literally impossible to know. I think better security is clearly needed in that environment, however.

Defense and impression management are key in forensics.

If the clinician does not engage transference in a manner that is beneficial, then the clinician risks everything.

If the clinician does not create an area that is safe, everything is risked.

Says the guy who lives in a veritable fortress with 3 other expert witnesses.

I have no idea what you are saying.

No, we don't know that, it is literally impossible to know. I think better security is clearly needed in that environment, however.

I understand your point, but what you are saying is a little out of touch with reality. That psychiatrist WOULD be dead without that gun and it is perfectly reasonable for any sane person to think that since the guy fired 10 shots at the psychiatrist and had 39 more rounds on his person he had plans to kill more people. Seeing how he'd killed one woman point blank and shot at another man 10 times, you find it important to argue we didn't know his intentions? Whatever. People on the internet will argue about anything. I just want to have a conversation about safety, geez.

How you would improve security?

I wonder if they'll tell him he can't bring his gun to work anymore because of company policy. He'll always have the trump card, "I'd like to have in my desk. Remember that one patient?"

As far as I've heard he received no punishment in any way and still works there. Not that I think he should be punished.

 

[WisNeuro]

I don't think he was out of touch with reality. It was an unknown situation. People threaten with guns all the time and don't use them. Situations can be handled a myriad of ways, with many possible endings. So, PSYDR is right, it is impossible to know. We can guess what would have happened, but we don't know for sure. In this case, it seems that the shooter didn't start until after an argument started, which leads me to believe that the situation had the possibility of being deescalated.

I believe the point of contention for safety was that some people feel like the answer to creating a safer environment isn't the NRA party line of "More good guys with guns!" The data doesn't bear that ridiculous thought out. Rather, what kind of institutional safeguards can be managed? Considering the patient population and sheer number of patients in the system, I think the VA does a fairly good job at mitigating risk factors. Behavioral flags, behavioral review committees, and it probably doesn't hurt that we have our own federal police force on the grounds. The question would be, what do smaller hospitals/clinics do? And, we would also probably want to consider base rates and confirmatory bias. We're hyper aware of these things because it's our field, but it's still a very rare phenomena when you consider the number of practitioners and number of patient encounters.

 

[GoPokes]

That psychiatrist WOULD be dead without that gun

This is an assumption. There is no way we can say with 100% certainty that if that psychiatrist did not have a gun that he would be dead or that other people would have died. We can make guesses based on the limited contextual information we have, but knowing what "definitely" was going to happen is impossible.

 

[Therapist4Chnge]

To borrow a phrase from the VA, "it is more likely than not" the most probable outcome. The psychiatrist already was shot once and the shooter had dozens of more bullets to keep at it. The shooter already killed the SW in cold blood, so it isn't a leap to consider killing others was a strong possibility.

 

[WisNeuro]

To borrow a phrase from the VA, "it is more likely than not" the most probable outcome. The psychiatrist already was shot once and the shooter had dozens of more bullets to keep at it. The shooter already killed the SW in cold blood, so it isn't a leap to consider killing others was a strong possibility.

True, but the shooting did not start until after the argument. A strong possibility, of course, a certainty, can't say. From what we know, I'm not sure arming every MH provider is the answer. We already know from numerous research that merely being armed in some way makes people less likely to engage in defensive behaviors and more likely to engage in confrontation. Is that a climate we want to foster in mental health treatment settings? Or should we look at more institutional changes?

 

[smalltownpsych]

As usual with these stories, not too many details. What was the argument about? I am not saying this is what happened in this case, I have actually seen these types of scenarios play out almost every day in mental health settings. Patient X wants to spend their disability check on beer or cigarettes or date patient Y or just not take their meds or fill in the blank. Professionals decide that is not in the patient's best interest, they order patient to change their behavior and begin to threaten consequences including involuntary hospitalization for non-compliance with their commands. Patient gets agitated and sometimes gets so frustrated that they become threatening, thus providing evidence of "see how they are when they don't take their meds". Eventually patient gets labeled as "burning too many bridges" and efforts are made to get rid of them. It is disturbing how often this plays out and is never challenged because the patient is always wrong and the professionals are always right.

 

[smalltownpsych]

By the way, the one place that I have worked that i did not see this dynamic play out or get interrupted and challenged was at a VA. At the VA where I did a practicum, the psychologists tended to be in charge and did a good job fostering a healthy therapeutic environment. So it can be done better. I think part of the difficulty is that in many of these settings psychologists are not present or are in an adjunctive role.