Do You Feel Like This Is A Dangerous Field?

[JackD]

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From what i hear, most people with psychological disorders is not dangerous to other people. However, if you actually work with people who have disorders, on a daily basis, do you feel as if you are constantly under the threat of violence? Like if you work in a psychiatric facility, does it seem like you need to constantly be on your toes or are things almost always calm?

 

[sparkleflower]

I think it can be. I work in emergency services, and while I haven't been directly physically threatened by a client (yet), it happens. I very recently TDOd a guy who subsequently tore a pipe out of the wall and attacked a couple of staff members. Our section of offices is locked as a result of a client who brought in a shotgun.

But it's really not scary at all. I think we all have clients we have to avoid in the office if possible, but few are really dangerous. And you can minimize the risks. Use those crisis intervention skills ;-) Mostly, I think it's mostly common sense stuff. You know, like stay alert and aware of the client and your surroundings. Stay out of reach of a potentially combative client--don't let 'em get close enough to hit or kick you. Don't let the client get between you and the door. If security and/or police are present, they stay between you and the client. Things like that.

Don't worry. If you work with these clients, you'll get lots of training and advice from more experienced coworkers 🙂

 

[baylordude]

From my experience in the behavioral mod arena, I've been kicked, punched, bitten, shoved, cursed at and threatened, had a drinking glass crushed on the side of my neck, dodged objects (including a fax machine, a hammer, a chair, and a butter knife), and have been spat on numerously. While my senses were definitely on high alert initially, I've grown accustomed to it - I now have autonomic cat-like reflexes [doing the crane stance]. So, I don't feel like I'm on my toes necessarily, but the average lackey probably would be during the first several months of exposure. Keep in mind, once again, that this speaks of my individual experience in the institutional setting with extremely psychotic patients.

Since recently attaining a management position, however, the "excitement" is slightly more pervasive. In the last 36 hours, I've had emergency on-call situations which included a guy who broke his toe subsequent to getting it caught between his bed frame and mattress, a situation in which a client beat a staff with his helmet, one involving a gal bladder rupture, and another involving indecent client behavior in the presence of children.

Soooo, I'd suggest buying a full-body Kevlar suit if you plan on doing entry level work in a similar setting. Once you get into management, you can take it off on occasion. 😉

 

[JackD]

So which of these disorders are actually dangerous? Borderline, antisocial, schizophrenia, bipolar, drug dependence?

 

[RayneeDeigh]

So which of these disorders are actually dangerous? Borderline, antisocial, schizophrenia, bipolar, drug dependence?

I wouldn't suggest labeling any of the above groups as "actually dangerous." Any human being is dangerous given the right circumstances and precipitating life events. I'm sure common sense suggests that your average person with antisocial PD who rates high on the psychopathy checklist is likely to be more violent than the average depressed housewife, but I'm not sure pointing it out is helpful.

I just did a paper though about how people with Borderline PD are marginalized and viewed as difficult in treatment settings so I'll admit to being quite sensitive to labels at the moment.

 

[blindchaos]

I agree with Raynee - anyone can potentially be dangerous. Having worked in group homes, there are a lot of different things that can make clients angry/upset/aggressive. Coming from a state hospital to a group home can be very challenging for some people regardless of diagnosis. It can definitely lead to highly dangerous situations and while it can be incredibly stressful, I'm glad I'm getting this experience as it is definitely helping me to be more comfortable in potentially dangerous situations (and is helpful in making me more assertive which is something I definitely needed/need to work on). Not that I don't see it as dangerous, I'm just more comfortable knowing that I can handle myself and others in the house in a variety of crisis situations.

The rapport developed with clients can be a HUGE help in a crisis situation. A new person coming in, even highly skilled and experienced, can make a situation worse by not knowing what tactics help specific clients and instead using something that makes them angrier even though it may seem like a good general intervention.

 

[Cosmo75]

Sure it can be dangerous. We're working with things that people don't necessarily want to discuss, let alone change, and we have to push them sometimes. A reaction in some can be violence. I agree not to label dx'es as dangerous. I've worked with 2 BPD clients, and 1 wouldn't hurt a fly and the other was a bit more aggressive but I never felt afraid. But would my guard be up a little bit more when working with a convicted murderer? Probably 🙂

 

[deleted176373]

As above, Humans... not particular subgroups, can be dangerous animals.

Mark

 

[JackD]

As above, Humans... not particular subgroups, can be dangerous animals.

Mark

Fair enough. However, we can all admit, certain disorders are more likely to cause agressive behavior. Agression is even a criteria for some disorders.

 

[RayneeDeigh]

Fair enough. However, we can all admit, certain disorders are more likely to cause agressive behavior. Agression is even a criteria for some disorders.

I would argue that generalizing doesn't help the clients at all, and would likely make clinicians too nervous to do much good either.

Take Borderline PD for instance (since it's the one most recent in my mind). Yes difficulty controlling anger is a criterion, but that there are 126 "ways" to have the required five of nine criteria (go go gadget combinations formula...) so the chances are high that quite a few individuals diagnosed with Borderline PD will not have any more difficulty controlling anger than any of us sitting here talking about it. If you're sitting in a therapy setting with one of these people and are thinking "oh god BPD, that means this person's probably readily aggressive" you're probably not going to establish the rapport that you otherwise could have.

Plus, there is far more variation within diagnoses than you'd think. Just 'cause someone with schizophrenia is violent and aggressive one day doesn't mean that he/she won't be perfectly harmless the next.

 

[Therapist4Chnge]

I think I've mentioned before I worked with SED kids who had a range of Dx's. I had one altercation (not with one of my kids, but with an EH kid), and though I never felt threatened, it was still a bit hairy.A rather large student lost it and threw a piece of wood at me, it left a mark...but nothing too serious. The rocks she threw would have been more problematic if she connected with one. She had a long history of violence, so I think it had more to do with her, and less with any dx. Though I'm 6'1" and pretty athletic, she probably outweighed me by 20lb....that was a bit odd.

The vast majority of settings are safe, and people shouldn't worry. In places like prisons and the like, there are rules for a reason, and generally are safe. It is important to be aware of your surroundings, know where to work in the room (never having the patient between you and the door, etc), and be attentive to body language.

 

[psychwanabe]

I think I've mentioned before I worked with SED kids who had a range of Dx's. I had one altercation (not with one of my kids, but with an EH kid), and though I never felt threatened, it was still a bit hairy.A rather large student lost it and threw a piece of wood at me, it left a mark...but nothing too serious. The rocks she threw would have been more problematic if she connected with one. She had a long history of violence, so I think it had more to do with her, and less with any dx. Though I'm 6'1" and pretty athletic, she probably outweighed me by 20lb....that was a bit odd.

Yeah, I'm not going to lie: I have no idea what these initials stand for. 🙄 Can you give a first-year a clue?

The vast majority of settings are safe, and people shouldn't worry. In places like prisons and the like, there are rules for a reason, and generally are safe. It is important to be aware of your surroundings, know where to work in the room (never having the patient between you and the door, etc), and be attentive to body language.

There's a good article about this in the Monitor this month with some of these tips.

 

[Therapist4Chnge]

Yeah, I'm not going to lie: I have no idea what these initials stand for. 🙄 Can you give a first-year a clue?

Those are actually educational classifications....

SED = Severely Emotionally Disturbed
EH = Emotionally Handicapped

There's a good article about this in the Monitor this month with some of these tips.

Neat. I've seen stuff like this is in the past, and people would benefit from making themselves familiar with some of these tips.

 

[73BARMYPgsp]

From the OP-

Do You Feel Like This Is A Dangerous Field?

No

 

[JackD]

From the OP-

Do You Feel Like This Is A Dangerous Field?

No

Maybe i will carry some can of pepper spray, just in case.

 

[73BARMYPgsp]

Maybe i will carry some can of pepper spray, just in case.

Nothing wrong with that. There are all kinds of low base rate events that we protect ourselves from every day. If you start bringing your own parachute on commercial jet travel, then I would say you have become paranoid.

 

[ProZackMI]

From what i hear, most people with psychological disorders is not dangerous to other people. However, if you actually work with people who have disorders, on a daily basis, do you feel as if you are constantly under the threat of violence? Like if you work in a psychiatric facility, does it seem like you need to constantly be on your toes or are things almost always calm?

As a former psychiatrist working in a hospital-setting, I have been grabbed and scratched on a few occasions, had my testicles squeezed violently once in residency (I can still feel that one!), and have been called exceptionally profane and insulting names, but...all of these things happened when working with pt's with substance-induced psychosis, extreme paranoia from schizophrenia, or OBS. It was not something that happened commonly, but it's something that does and will happen when you work with people with mental illness, especially in an inpatient setting.

 

[deleted190534]

I think I've mentioned before I worked with SED kids who had a range of Dx's.

Same here...but in a much different capacity. (I just got into grad school.) My husband & I were foster parents for a number of years. We "upgraded" our license to work with "emotionally & behaviorally disturbed children." We mostly had preteens & early teens. Anyway...

That situation was dangerous for us, but primarily because of one child & because of the capacity we were in - in relation to her. (She would have never considered harming someone she only saw once a week.) That particular child actually tried to kill me. Luckily, she was very immature & naive in her attempt, so I'm still here to write this. Interestingly, she wasn't one of the kids that would arbitrarily or repeatedly attack me; she didn't like face-to-face confrontation. She preferred to operate covertly. (That made her a lot more scary to me!) We had her for 1.5 years, & after several months, we figured out just how sick this poor child was (cruelty to animals & children, enuresis, perpetrator, etc.). We ended up having to put alarms on all of the bedroom doors & doing "line-of-sight parenting." I hate to admit it, but I literally had PTSD symptoms even after she went into residential care. (There's something so unnatural about locking the door at night -- only to think that it's ironic that the greatest immediate danger to you & your family is someone locked behind that door with you.)

Anyway...we had lots of other incidents with violent & aggressive kids. I had my front tooth knocked out, & a different child tried to push me down the stairs. I can't even count how many times I was pushed, hit, kicked, pinched, & bit. Somehow, those things weren't that "scary" to me...or I didn't perceive them as SO dangerous or anything. Like someone else said, you kind of get used to it. It has to be bumped up to a whole different level for me to feel in danger.

 

[JackD]

have been called exceptionally profane and insulting name

That is a daily occurrence for me (i have siblings).

testicles squeezed violently once in residency (I can still feel that one!)

I sort of can too. So pepper spray and a cup? Got it. 👍

OBS.

OBS? I don't recognize that acronym, which disorder is that?

Like someone else said, you kind of get used to it.

I would imagine. Sort of like how a cop who is a twenty year veteran doesn't get nervous when going to work.

 

[blindchaos]

I would imagine. Sort of like how a cop who is a twenty year veteran doesn't get nervous when going to work.

It's definitely something I've adjusted too. It also helps that generally, the threats that are made are not realistic (sorry client, I'm not small enough to fit through our paper shredder!). Now it's really not that big of a deal. During an interview (for a job in a crisis unit, NOT for PsyD/PhD admission), I was asked "Have you ever been threatened before?" I tried *really* hard not to laugh Now if someone is swinging around a machete, that's a different matter! (saw that actually out in public - appeared to be a gang fight)

 

[ProZackMI]

That is a daily occurrence for me (i have siblings).



I sort of can too. So pepper spray and a cup? Got it. 👍



OBS? I don't recognize that acronym, which disorder is that?



I would imagine. Sort of like how a cop who is a twenty year veteran doesn't get nervous when going to work.

Jack,

OBS = Organic Brain Syndrome, a cluster of symptoms due to TBIs (traumatic brain injuries), CHIs (closed head injuries), anoxia (lack of oxygen to brain with resultant brain damage), hypoxia (low O2 to the brain with brain damage), CVA (cerebral vascular accident or stroke), TIAs (transient ischemic attacks or mini-strokes), or long-term exposure to EtOH (alcohol) or drugs.

Here's the thing. If you're truly interested in mental health, whether as a psychologist, social worker, LPC, psychiatrist, or NP/PA, you'll have times where you might be apprehensive, shocked, or even downright scared. When I was a resident, I saw a skinny 19-year-old kid who was stoned off his butt on heroin and cocaine lift a 200+ pound orderly and literally throw him into the wall. I've seen patients who are calm and placid one minute, turn violent and attack other patients or nurses without any logical reason.

The real answer to your question lies in the setting where you will be working. If you choose an inpatient facility, be prepared; anything and everything will happen. If you're in CMH, rarely will such things happen. If you're in private practice, and you select your patients/clients, then it's a fair bet, you'll be safe from such acts of violence.

I wouldn't worry about pepper spray. Such things may not be effective against a truly psychotic person who's in mid-rage. I've seen taser guns have little effect on some patients. Plus, most hospitals have strict rules about weapons.

If you're interested in MH, I would say the setting of your employment will often determine your potential exposure to harm. Most psych units and hospitals make great efforts to medicate or restrain those patients deemed to be a threat to staff and other patients. Unless you're going to into psychiatry, I doubt you'll have much exposure to patients like that. I would guess that if you go into SW or psychology, you'll mostly be dealing with a full range of affective D/O, a lot of anxiety disorders, adjustment D/O, EtOH and Polysub dependence, childhood/adolescent conduct D/O and ODD, ADHD, LD NOS, and a wide range of personality D/O. It's doubtful you'll encounter many true schizophrenics.

If you're working in a rehab/detox center, then you may encounter intox patients who have sub-induced psychosis; this can be dangerous, but in most places like that, there are security measures to ensure staff safety. Don't let the potential for violence scare you away from the MH field.

Best of luck,
Zack

 

[Therapist4Chnge]

Great post Zack.

I agree with everything, particularly the detox comments.

 

[myelin]

I agree with Zack, especially reagarding the evnts occuring on an IP unit. I worked as a mental health technician (aka orderly, tech) at a behavioral health unit that took acute patients who were in crisis as well as those who were suicidal, psychotic, dual diagnosis, substance abuse (currently intoxicated as well as those in withdrawl)...I saw a lot while working there for a year. I worked on both the child/adolescent and adult unit. Suprisingly, the adults were relatively calm when compared to the adolescents. At 5'10" and 180 lbs., I was on the light side of things very often and had to rely on other staff members to help when patients would "go off."

That said, yes, there were times when I was scared to death of the 12 year old female who was 300 lbs, had fetal alcohol syndrome, multiple sclerosis, HIV+, and loved to bite her lip until it would bleed and spit at staff members. She was a walking vile of Zyprexa which was depressing because she did respond fairly well to behavioral contingencies.

Other times the patients were like close friends to me and I enjoyed watching them progress over their short 1 to 1.5 week stay. I still have many of the drawings that the kiddos drew for me that to this day still hang on my wall. They touched me in such a way that I knew that clinical psychology was the place I needed to be. The IP unit really opened my eyes to what a mental illness really looked like versus what Hollywood portrays them to be to the general public. The unit wasn't some place with zombies drooling and going "crazy" all over the place. It was a place with real people suffering from real disorders.

I can't speak for any other setting but IP, but I will say that if you plan on working IP, it can be dangerous at times. I found that staff members become more than just staff members for your 8 hour shift - they become partners that watch your back as you watch theirs. When the unit goes off and riots, you need all the support you can get and it can get dengerous. I'd say though that the good times and the progress that was made on that unit far outweighed the bad times.

 

[ProZackMI]

I agree with Zack, especially reagarding the evnts occuring on an IP unit. I worked as a mental health technician (aka orderly, tech) at a behavioral health unit that took acute patients who were in crisis as well as those who were suicidal, psychotic, dual diagnosis, substance abuse (currently intoxicated as well as those in withdrawl)...I saw a lot while working there for a year. I worked on both the child/adolescent and adult unit. Suprisingly, the adults were relatively calm when compared to the adolescents. At 5'10" and 180 lbs., I was on the light side of things very often and had to rely on other staff members to help when patients would "go off."

That said, yes, there were times when I was scared to death of the 12 year old female who was 300 lbs, had fetal alcohol syndrome, multiple sclerosis, HIV+, and loved to bite her lip until it would bleed and spit at staff members. She was a walking vile of Zyprexa which was depressing because she did respond fairly well to behavioral contingencies.

Other times the patients were like close friends to me and I enjoyed watching them progress over their short 1 to 1.5 week stay. I still have many of the drawings that the kiddos drew for me that to this day still hang on my wall. They touched me in such a way that I knew that clinical psychology was the place I needed to be. The IP unit really opened my eyes to what a mental illness really looked like versus what Hollywood portrays them to be to the general public. The unit wasn't some place with zombies drooling and going "crazy" all over the place. It was a place with real people suffering from real disorders.

I can't speak for any other setting but IP, but I will say that if you plan on working IP, it can be dangerous at times. I found that staff members become more than just staff members for your 8 hour shift - they become partners that watch your back as you watch theirs. When the unit goes off and riots, you need all the support you can get and it can get dengerous. I'd say though that the good times and the progress that was made on that unit far outweighed the bad times.

This is dead-on accurate. There are real people in IP settings with serious problems -- long-term problems that go beyond just medication and therapy. Many of these people will never be able to sustain employment or live independently. When you're working in a psychiatric hospital, you will see it all eventually, trust me. The good, the bad, and mostly, the ugly.

I've seen non-clinical staff abuse the patients, and seen fellow psychiatrists damn near kill patients by overmedicating them or not considering contraindications with other meds or co-morbid conditions, especially HTN, NIDDM, seizure D/O, and a whole host of other conditions that were overlooked. I also was shocked to see how many patients were neglected medically (e.g., their non-psych conditions left under or un-treated).

Oh, you'll see a great deal of things, but for the most part, you'll be safe. If blood, feces, urine, saliva, semen, and tonight's dinner don't bother you, you'll be fine 🙂

Just kidding. It can be messy at times, though.

 

[JackD]

When you're working in a psychiatric hospital, you will see it all eventually, trust me. The good, the bad, and mostly, the ugly.

It has never really been my goal to work in a psychiatric hospital though. I always thought that some kind of outpatient clinic, general hospital, or private practice would be my thing. I suppose i don't know 100% at this stage but right now, that is where i think i would like to end up. I guess there could be some points where i would have no choice but when i am finally free to do what i want, i'm not sure working at an inpatient facility would be for me.

Really i think that behavioral medicine/health psychology is what i want to do but that is years off. However, I feel pretty confident about three jobs that while I wouldn't so much hate doing them, are lower on my list of desired psychology careers (i have felt this way long before this thread started); teaching, researching, and working in an institution (mental hospital or prison).

 

[Sahoodi]

I would have to echo what seems to be the consensus: people in general can be unpredictable and dangerous, but good de-escalation skills and awareness can keep you safe most of the time. I've supervised a busy shift in a county detox for 3 years and only been assaulted once (by a 20 year old female college student, surprisingly). However, I don't dare try to count the number of situations that could have led to assault.
The best approach, in my humble experience, is to stay vigilant and not get complacent about safety. That means being aware of your physical position in reference to a client, attending to the direction of their emotional state, and asking for help (other counselors or law enforcement) when your gut says so. I would say that drug/etoh intoxication raises the probability of violence, but it's difficult to prototype which client will choose that option. I'd go so far as to say that you're in the most danger when you believe that any person is completely incapable of violence!

 

[myelin]

I would have to echo what seems to be the consensus: people in general can be unpredictable and dangerous, but good de-escalation skills and awareness can keep you safe most of the time. I've supervised a busy shift in a county detox for 3 years and only been assaulted once (by a 20 year old female college student, surprisingly). However, I don't dare try to count the number of situations that could have led to assault.
The best approach, in my humble experience, is to stay vigilant and not get complacent about safety. That means being aware of your physical position in reference to a client, attending to the direction of their emotional state, and asking for help (other counselors or law enforcement) when your gut says so. I would say that drug/etoh intoxication raises the probability of violence, but it's difficult to prototype which client will choose that option. I'd go so far as to say that you're in the most danger when you believe that any person is completely incapable of violence!

That is an excellent point you make about having de-escalation skills and awareness. As such, the job isn't cut for anyone. I've worked with techs that have ego inferiority complexes that instigate patients to the point that they can justify restraint and PRN meds.

There is only so much that you can learn in your psych textbooks while the rest must be lerned on the unit. You can read about schizophrenia and the subtypes until you are blue in the face, but that won't necessairly prepare you to handle a patient with delusional thoughts. It may, however, prepare you to work with catatonia 😉

But back to de-escalation techniques - we prevented many codes on the unit by working as a team to help the patient through the crisis situation. With children, giving them a choice was effective (i.e. telling them, "you may go to your room and lie down until you are calm enough to join us, or you may go to the quiet room and sit on the concrete floor. the choice is yours.") Engaging in power struggles with patients almost never worked and most often resulted in codes that could have been prevented otherwise. Giving a choice gave them a sense of empowerement and autonomy as well as giving them space to calm down for a few.

My point -yes, there are dangerous patients out there. I believe, however, that an undertrained staff member working on an IP unit is more dangerous than a patient and their diagnosis. A properly trained staff member who is aware of how to handle situations ensures the safety of both the staff and the other members of the mileau. Without proper training and experience, the IP unit can be a dangerous place for everyone, staff and patients included. A therapeutic environemnt can not be maintained if staff members can't effectively handle patients with behavioral/psychiatric issues.