Safety in community mental health setting

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15+ Year Member
Sep 29, 2008
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For people who work in CMHC how do you handle SMI patients who have a violence history when decompensated? If a patient is not sick enough for involuntary hospitalization but with increasing paranoia & irritability and has a history of assaults when paranoid, does your clinic have safety precautions in place? If so, what are they? Are they adequate? Why or why not?

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In my experience, this varies extremely widely. The best setup clinics are attached to inpatient county psych units with all of their associated support staff. At the bare minimum there should always be some sort of contracted security personnel on site and panic alarms at every desk. Most community health patients will be headed towards or coming from inpatient mental health admissions, so your experience above is common and a major stressor for those working at such facilities (and source of burnout).
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The community mental health where I worked had no security. Small town so not too hard to get police to help if necessary. I have typically been the guy called in to deescalate and communicate in many of the settings I have worked and if I can’t then it’s usually easy for the cops to take over at that point. One good strategy is to have multiple people there. I am much more comfortable taking them down or through whatever it is when there are a lot of people behind me, even if the backup are of less physical ability. We called it a show of force at one site and it was fairly effective.
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