Managing the violent patient: A guide for psychologists and other mental health professionals.

Abstract

Being threatened, harassed, attacked, or confronted by a patient with a weapon is becoming more common and is likely to occur at some point in a mental health professional's career. Effective violence management programs can reduce the incidence of violence. Yet, few resources have been provided to assist psychologists and other mental health professionals to deal with aggressive patients. The authors offer strategies for the management of aggressive behavior that can be implemented to empower practitioners to take precautions when necessary in a quick and efficient manner when dealing with violent and potentially violent patients. What would you do if your next patient were violent? Are you prepared to handle a violent patient? Assume your next patient arrives for a scheduled session and you notice a gun in the patient's briefcase. What would you do? Or what if your next patient discloses a plan to injure a coworker and threatens harm to you and your loved ones if the plan is disclosed to anyone, including authorities? How would you handle these situations on a short- or long-term basis? Rapid and efficient management of violent and potentially violent patients is a critical skill. Violence management is needed by inpatient and outpatient mental health professionals in this era of managed care (i.e., minimal inpatient stays, limited and inexperienced staffing). The pervasiveness of aggression in acute psychiatric and other mental health settings has been documented. Employees staffing one urban psychiatric emergency service identified 99 Of 1,806 consecutive patients as violent or potentially violent (Beck, White, & Gage, 1991). A survey of 300 independent practitioners revealed that 81% experienced at least one incident of patient physical attack, verbal abuse, or other harassment (Tryron, 1986). Armed police in acute psychiatric facilities and pharmacies, panic buttons, and metal detector searches of patients have become the norm (McCulloch, McNiel, Binder, & Hatcher, 1986). Psychologists and other staff often have little or no training regarding the management of potentially violent patients. We