Clinic Security

[keifernny2]

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So, with the recent clinic violence (and history of violence in the past), what are everyone's thoughts about good security protocols for behavioral health clinics?

I work in one (for profit) CMHC /clinic with a security guard, panic buttons, security doors, and evacuation drills.

I work in another clinic (federal) with none of those things and everyone says "don't worry about it."

Anyone with any other clinic practices that make them feel safer?
Or has anyone ever left a job because they don't feel safe in the work environment?

 

[F0nzie]

I wish I had some data on violence at CMHCs and what the risk is. There is 0 security at my site and it makes me feel a bit uneasy. We have had a number of violent incidents in the last 2 years. I have witnessed the knocking + choking out of staff and a pregnant lady getting kicked in the abdomen.

 

[birchswing]

I think it goes back to changing society. I'm sure there are some reasonable measures you can take to mitigate the failings of society. But look at the Fort Hood shooting.

A psychiatrist murdered 13 human beings on a military base.

You wouldn't expect there to be a safer place to be. In that immediate moment, what more could have been done? It's the things leading up to that moment and that are happening right now you have to look at.


When I say changing society, I mean going back to investments in individuals at a very broad level. It's a whole theory of national development through human development. It's the model that has produced the most stable, least violent countries with the highest levels of human welfare.

Edit: As an example of what Im talking about you can look at theory on the more capitalist/political freedom side from Amartya Sen or look at the Nordic model of developmental welfare (welfare as a model of developing the state). They overlap a good deal. Both begin with the idea that the development of society is linked to the rights or needs of individuals. States that fail to provide rights or for needs tend to be states that have poverty or violence.

 

[erg923]

So, with the recent clinic violence (and history of violence in the past), what are everyone's thoughts about good security protocols for behavioral health clinics?

I work in one (for profit) CMHC /clinic with a security guard, panic buttons, security doors, and evacuation drills.

I work in another clinic (federal) with none of those things and everyone says "don't worry about it."

Anyone with any other clinic practices that make them feel safer?
Or has anyone ever left a job because they don't feel safe in the work environment?

Who says "don't worry about it" and on what evidence are they basing this on? Does this person see patients?

 

[sunlioness]

There doesn't seem to be any real security where I am now. At least in terms of access. Anyone can walk in and go wherever. I mean, you can call security. And though I haven't had to, I'm told they respond quickly. How quick is quick enough though? Like yesterday. A guy who wasn't my patient comes into my office uninvited. Big guy. Closes the door behind him and LOCKS it. Then he looks at me and calmly asks to speak to the "behavioral health manager". I point him the right direction. He thanks me and leaves. Scared me though. There doesn't seem to be a panic button in here either. My last place had one. I only used it once, but that's because a patient started having a seizure. Not because I was unsafe. Though I did once have a patient there who was discharged for making homicidal threats against multiple doctors. They beefed up security for a few days. Had a guard stationed out front and checking the parking lot. If he'd really wanted to kill someone (and I don't think he actually did), I'm not sure those measures would have prevented him from doing so.

But I just got to thinking yesterday . . . I think most schools now have more controlled access than most hospitals and mental health centers. And schools have all kinds of safety drills these days. I've never worked anywhere that offered any kind of training on what to do if someone shows up with a gun.


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[FlowRate]

The majority of people I know with a CCW never, ever want to shoot someone, yet sometimes I understand the need to be your own security.

 

[keifernny2]

Who says "don't worry about it" and on what evidence are they basing this on? Does this person see patients?

Unfortunately, they are the administrators that would be the ones that need to budget/ install this type of equipment.
The question is, how much is necessary?
Either way, I suppose when you don't feel safe you can always vote with your feet and quit.

I know a number of Behavioral health providers that carry pepper spray on them, though few that carry a weapon.

 

[Shikima]

Unfortunately, they are the administrators that would be the ones that need to budget/ install this type of equipment.
The question is, how much is necessary?
Either way, I suppose when you don't feel safe you can always vote with your feet and quit.

I know a number of Behavioral health providers that carry pepper spray on them, though few that carry a weapon.

http://www.nationalreview.com/article/384797/when-psychiatrist-shoots-kill-robert-b-young

 

[birchswing]

The majority of people I know with a CCW never, ever want to shoot someone, yet sometimes I understand the need to be your own security.

I think it's important to remember that in this recent shooting at a clinic for people with developmental disabilities, the perpetrator was an employee, just like with the Fort Hood shooting, where the killer was a psychiatrist.

I don't say this to be glib, but it's not an exaggeration to say that a good number of psychiatrists in my area struggle with substance abuse and are not necessarily the most stable individuals.

I don't know that there is any evidence from which we should believe that a psychiatrist is more at risk from being murdered by a patient than vice versa, and I don't believe either should have a gun on the premises of a mental health facility. I don't see a problem in having well-trained police officers, but I think going the way of the wild west with everyone carrying guns is just that: going the way of the wild west.

 

[keifernny2]

I think that there is a critical mass / office size where hiring police / security officers makes sense , though what size that is, I do not know. It seems that a facility with 4 prescribers would already be billing over $2 million in revenue, and counting therapists & other professionals it seems like it wouldn't require much to justify some sort of security presence.

 

[smalltownpsych]

Unfortunately, they are the administrators that would be the ones that need to budget/ install this type of equipment.
The question is, how much is necessary?
Either way, I suppose when you don't feel safe you can always vote with your feet and quit.

I know a number of Behavioral health providers that carry pepper spray on them, though few that carry a weapon.

The friggin' administrators. The proper answer is that there needs to be plans and training to address crisis situations. Having an armed guard might not be the best solution to make things safer, but having plans and training for deescalating patients and addressing their complaints can. Also having a healthy and supportive work environment is likely to be protective. Unfortunately, many of these places are so poorly run that the staff end up as distressed as the patients. The good people leave and the bad ones stay and the downward spiral continues.

 

[FlowRate]

I think it's important to remember that in this recent shooting at a clinic for people with developmental disabilities, the perpetrator was an employee, just like with the Fort Hood shooting, where the killer was a psychiatrist.

I don't say this to be glib, but it's not an exaggeration to say that a good number of psychiatrists in my area struggle with substance abuse and are not necessarily the most stable individuals.

I don't know that there is any evidence from which we should believe that a psychiatrist is more at risk from being murdered by a patient than vice versa, and I don't believe either should have a gun on the premises of a mental health facility. I don't see a problem in having well-trained police officers, but I think going the way of the wild west with everyone carrying guns is just that: going the way of the wild west.

But I didn't say arm all psychiatrists (and apparently according to you the majority are unstable addicts.) I basically said that it makes sense that some people choose to carry a weapon, despite the rules against doing so (in case you didn't read the linked article), especially in the case where the administration is not providing appropriate security (the topic of the OP.)

I'm not otherwise interested in touching on the "wild west," except to say that I'm from part of the "wild west" where people open and concealed carry on a regular basis and it's really not a big deal. As for the rest of that potential argument, there's not much I can say that's not covered in this blog post.

Here's a link to a cached mirror of that post, because his website is being slow today (hug of death.)

 

[alina_s]

I've worked in 2 CMHC's and 2 small group private practices. Both CMHC's had better security than the private practices, but the private practices could be a lot more selective about which patients they took and kept. Both CMHC's had automatic locks on the doors between waiting rooms and hallways, so people couldn't just barge in. There wasn't a much beyond that, though. I worked at one CMHC for a little over two years and things seemed to get worse in that time. I moved offices three times and somewhere along the way, they gave up on re-wiring the panic buttons. I never used the panic button and orientation was so whirlwind that I have no idea what the response was supposed to be anyway. There certainly weren't any drills. Maybe it involved the manager who used to be a police officer? The last office, and the one I used the longest, was in a new addition that was terribly designed- rooms off of a skinny dead-end hallway (the original building had four wings with hallways in loops and emergency exits at the outside walls). The new offices were long and skinny, with doors on the skinny ends so that there was no way to leave patients and me with easy access to the door. That CMHC was the only agency in the area and I am not sure if they weren't allowed to fire anyone or just didn't take the threat seriously. One patient threatened to kill me if I got him hospitalized and continued to make specific threats while in the hospital. The local hospitals were miserable at coordinating care but this was one of two times in two years when someone from an inpatient team bothered to call me. The police took it seriously enough to check on my house but the clinic decided to let him see the other psychiatrist. He later assaulted the nurse manager in the clinic. Not sure if they finally decided to discharge him at that point- I had left by then. Dedicated security staff would have been excellent. Some input from clinical staff on the office design would've been good too. We weren't told about it until the design was finalized, and our input wasn't invited, but I couldn't believe the common-sense things they had overlooked. Sound insulation between rooms would've been a nice touch too.

 

[NickNaylor]

The majority of people I know with a CCW never, ever want to shoot someone, yet sometimes I understand the need to be your own security.

I went to a conference a month or two ago and one of the lectures I attended was essentially an overview of guns and gun violence for psychiatrists. I was pretty shocked at the complete lack of basic information with respect to firearms (i.e., even things as basic as distinguishing a rifle vs. a handgun vs. a shotgun), yet, perhaps even more interestingly, there was no shortage of hands in response to the "how many of you support complete gun bans" question. I was one of maybe three or four people in a room of 70-80 that raised their hand when asked who owns a firearm.

I know it's a bit off topic, but that's what your blog post reminded me of.

 

[FlowRate]

I went to a conference a month or two ago and one of the lectures I attended was essentially an overview of guns and gun violence for psychiatrists. I was pretty shocked at the complete lack of basic information with respect to firearms (i.e., even things as basic as distinguishing a rifle vs. a handgun vs. a shotgun), yet, perhaps even more interestingly, there was no shortage of hands in response to the "how many of you support complete gun bans" question. I was one of maybe three or four people in a room of 70-80 that raised their hand when asked who owns a firearm.

I know it's a bit off topic, but that's what your blog post reminded me of.

There's a lot of willful ignorance. I mean, CA has the most strict gun control in the country, yet (already touched on in that blog post), half of the articles I've seen come out of this latest event seem to think that there aren't even "basic gun control laws."

I've been thinking about starting a thread here about the "mental health" thing. I thought "mental health" was a right-wing scapegoat to try and take focus off of "gun control" but it seems like everyone is on that page now. I'm simply having a hard time being convinced that 1. people should be banned from buying firearms because they have "anxiety." 2. that there should be a state-owned record of people with "mental health problems" 3. the "MH" problems that lead to mass shootings are (readily) treatable/predictive (is religious extremism a mental health problem? behavioral disregulation?)

 

[keifernny2]

Bringing it back on topic....
On the few occasions I've had to go to the courthouse, I always have to go through a metal detector.

On vacation in Europe last year, I went to the mall and had to pass through a metal detector and have my packages scanned through an X-ray scanner.

I suspect there won't be any changes in most publicly owned or nonprofit clinics unless OSHA were to issue regulations requiring it. It seems as though with today's technology, wireless panic buttons could be installed with an interface to the fire protection and/or alarm system with very little trouble.