WASHINGTON COMMUNITY MENTAL HEALTH COUNCIL David Kludt, M.P.A., M.H.P. Program Administrator Ann Christian, CEO 1 www.wcmhcnet.org 2 On Behalf Of Employers And Employees Mental health employers in Washington State Working Together to Create a Culture of Safety 3 4 Safety is a Team Effort! Employers Responsibilities Success depends on ALL of Us! 5 Comply with all workplace safety regulations. Assure complete and current safety protocols. Provide thorough & effective staff training. Involve Staff on Safety Committees. Invite Consumer safety suggestions. Listen & respond to Staff & Consumer safety concerns & suggestions. Make improvements in procedures and practices as appropriate. 6 1
Employees Responsibilities Working together... We help assure Engage actively in all required trainings. Follow agency protocols and procedures. Prepare for challenging situations. Ask for help when needed. Alert employers to potential hazards. Offer suggestions for improving safety. Safety for everyone! 7 8 Washington State Department of Labor and Industries Washington State Department of Labor & Industries DOSH Disabled Lost Time Treatment Workers Comp Workers and employers contribute $ Barbara Silverstein Research Director for SHARP Website: www.lni.wa.gov/safety/research 9 Specialty Compliance Symptoms At Risk SHARP 10 Safety & Health Assessment and Research for Prevention-SHARP(a) A multidisciplinary team Epidemiology Economics Ergonomics Industrial hygiene Occupational medicine Occupational health psychology Public health Safety engineering Toxicology Database management and systems Support (many are adjunct or clinical faculty at UW)-> graduate students working on SHARP projects What we do: Track health and hazards related to work Develop strategies for injury/illness prevention Explore specific risk factors and health problems Test methods for identifying risks Where do we do it? Tumwater Ergonomics lab, IH lab Workplaces all over the state in many industries 11 Statistics To Be Aware Of 40% of mental health workers serving adult clients have been assaulted at some point during their career. 48% of all non-fatal injuries in the workplace occur in health and social services. Bureau of Labor Statistics, 2000 12 2
Assault Accepted Claims Rate, Outpatient Mental Health (NAICS 62140), 2000-2007* Claims per 10,000 FTE 180 160 140 120 100 80 60 40 20 0 Outpatient Mental Health Care All Health Care/Social - excl Psych Hosp Outpatient Care 2000 2001 2002 2003 2004 2005 2006 2007 Being assaulted is not an acceptable part of your job! * 2007 data still developing 13 14 Building a Culture of Safety 1. Assaults are preventable! 2. Safety requires collaboration between employer and employees. 3. Success requires everyone s buy-in and commitment, including full participation in trainings and frequent drills. 4. A safe workplace layout that inhibits physical assault. Assaults are 15 16 Many Safety Issues Are The Result Of: Prevention is about being PRO-ACTIVE Failures in planning. Failures to communicate. Failures to recognize deteriorating conditions. Failures to act. Pro-Active Trusting foresight I know it. Re-Active Trusting hindsight I knew it. 17 18 3
Accidents are bound to happen It s not a problem until it is a problem Accidents are part of the work we do There is nothing we can do for the client right now That looks like a potentially unstable situation I ll see if I can get some team time to brainstorm how to reduce the possibility of harm It is my job to call attention to anything I think increases risk - no matter how small. How early can we spot a pattern of escalating aggression? He has to reach bottom first 19 20 Management and Staff Create a safety plan Training and practice bolster everyone s safety! Find and fix problems Joint owners. Joint stewards. 21 22 Dept of Labor and Industries CONTACT INFORMATION Main line 1-800-LISTENS Employment standards/workplace rights 1-866-219-7321 Safety and Health 1-800-4BE-SAFE 1-800-423-7233 SHARP 1-888-667-4277 www.lni.wa.gov/safety/research We wish you well and look forward to reporting many fewer assaults in the future! 23 24 4
Aggression is not an alien or unnatural emotion. Over-arching Safety Principles By Ellis Amdur, M.A., N.C.C., C.M.H.S. 25 Yet, a mental health agency should be a safe haven for: - Our clients - Ourselves 26 The Overarching Principles 1. Fundamentals of a Safe Workplace 1. Fundamentals of a safe workplace 2. Fundamentals of threat assessment 3. Screening new clients 4. Hardening your perimeter 5. Safe communications 6. Threats to your family Each member you, a manager, supervisor, line staff assumes responsibility for creating an ethic in which safety and security are paramount: Do you care for each other? Do you feel taken care of? Do you give each other power? Do you have power? Do you treat each other with respect and dignity? Do you protect each other? Do you feel protected? 27 28 2. Fundamentals of Threat Assessment Stage 1 Stage 2 Stage 3 Stage 1: 1. Non-cooperation with people in authority. 2. Spreading defamatory information about others. 3. Frequent arguments. 4. Frequent use of obscene language, particularly that which is intended to be abusive, distressing or otherwise calculated to negatively affect others. 5. Repeated complaints of desperation regarding their family, finances or other problems. 6. Sexual innuendo, harassment. 7. Belligerence or bullying towards others. 29 30 5
Stage 2: Stage 3: 1. Easily escalates into arguments. 2. Refusal to follow company policies and procedures, if an employee, or conditions and agreements regarding services, if a client. 3. A heightened, hair-trigger sense of grievance. 4. Verbal or physical intimidation of others. 5. Sabotage or theft of property. 6. Romantic obsession with staff. 7. Extreme interest or excessive talk about weapons, implied violence, implied or veiled written or verbal threats. 1. Brandishing or showing a weapon. 2. Suicidal threats. 3. Property destruction. 4. Open threats to do harm to others. 5. Practical jokes that expose others to harm. 6. Physical assaults 31 32 3. Screening of New Clients 4. Hardening Your Perimeter Handout Ask direct questions about previous assault history and potential violence: Hold yourself calm, relaxed, non-confrontational manner, with a direct gaze. Convey that you are asking for the information to ground your understanding, not because you are afraid. Convey by your attitude that you feel confident to handle anything they might mention, even anger or threatening statements. 33 You must be prepared for the worst! Know your agency s safety plan. Rehearse it in your mind, every few days. Participate in regular drills. So you know what to do if things do go terribly wrong. 34 About About Hardening Your Perimeter 1. Strengthen your communication system Have emergency numbers on your speed dial phone. Whenever possible, use a land-line to call for help. Hardening Your Perimeter 3. Know your escape routes Go through your office space. Figure out best way to barricade offices that one could not easily escape from to leave the building. Have a working knowledge of your agency s alarm system and procedure. 2. Do NOT get beyond the horizon line Correct any limitations. If a door has a lock, support staff should have keys. 35 36 6
About Hardening Your Perimeter IMPORTANT 4. Prepare the grounds when anticipating a potential problem. Strategize, based on your collective knowledge of the person. Set up the room. Plan to have someone outside the room check to make sure the situation is not getting out of control. Who should be present in the room? Alert staff to the possibility of a show of strength. Be prepared to call police. Inadequate briefing of all necessary staff is a guaranteed formula to kindle people who are already on the edge. 37 About Hardening Your Perimeter 5. Plan preemptively with the person CLEARLY explain your policies. 6. Know when to call the police, and who should call. Police should be called: - In any case where anyone is at physical risk; - When aggressive individual is so disruptive that their behavior cannot be modulated and they are disrupting the activities of the place. 38 About About Hardening Your Perimeter 7. Consider what practices might set up a situation that contribute to an environment in which violence can occur. Hardening Your Perimeter 8. Consult with others regarding any interchange which was disturbing either to you or the client and/or other staff. Minimize the number of layers for people to get to the person who can actually help them. Debrief and strategize: attempt to understand the situation. Get up and guide people exactly where they need to be if they get lost. If there is a multi-layered screening process at your agency, consider asking only the questions necessary to help the person get to the next level. Find a fair witness : ask for advice. 39 40 Useful Tip How to enter a room to see whether there is a problem and extricate your co-worker: 1. Enter with apologies even profuse apologies 2. Use an excuse. 3. Apologize again as you usher your co-worker out. 4. Go down the hall out of range of the person and check out the situation. 5. If there is no emergency, accept their thanks for looking out for them. 41 Useful Tip When a dangerous situation develops: 1. Use your agency s alarm system to call for help (i.e. panic buttons). 2. When calling for help from your office phone: use agreed upon code words: Could Mr. Armstrong please come here with these records I was talking about? Could you please tell Dr. Huntington that I will be late for my next appointment? Could you ask Ms. McIntosh to call me? There s a matter regarding school authority that I don t understand. I need an immediate consult regarding policies 42 7
6. Safe Communication 1 Make sure that everyone is aware of changes in behavior or verbalization by any person of concern. 2 Each client s file should have a readily available place which includes information about the client s history of violence and risk profile. 3 There must be free communication of and respect for each other s gut feelings. 4 Discuss differences among you with respect. 5 Anger regarding another staff s treatment of a client is rarely brought on by the other s incompetence. 43 Useful Tip What if a co-worker is angry or aggressive? 1. De-escalate the same way as with any other person or client. 2. Do NOT accept any abuse from co-workers. 3. Repeat incidents, severe aggression, or ongoing patterns of aggression or intimidation, should be discussed with supervisory personnel or your Human Resource Department. 44 7. Threats to Your Family Do NOT give out personal information. See CD on Safe Office Space. Are you a soft target? Easily accessible, predictable, unaware? Safe workplace Threat assessment Handout Are you a hard target? Not easily accessible, not predictable, security conscious, in touch and aware of surroundings? 45 Screening new clients Hardening your perimeter Safe communication Threats to your family 46 Sgt Keith Cummings Police and Mental Health Personnel Sgt. Keith Cummings Spokane Police Department 25 year law enforcement veteran Co-creator of the Spokane Police Crisis Intervention team Vice-Chair Spokane Co. Mental Health Advisory Board M.S. from EWU in communications 47 48 8
Collaboration Why is this important? Why this may be necessary? What do we have in common? What are our differences? Safety awareness What do you think mental health staff are good at with respect to safety awareness? What do you think mental health staff need to work on? 49 50 Situational Awareness Situational Awareness We don t react to people, personalities or diagnosis. We react to behaviors. 51 Avoid the action imperative. You chose the location for contact. Make a note of where the exit doors are. Do not allow a person to get between you and an escape route. Keep the person in sight at all times. Are there other people in the home? You can still show empathy and be safe at the same time. 52 Situational Awareness Collaboration Plan for the worse and work towards the best situation. Listen to your own voice if it doesn t feel right leave try again later. Do you have any contacts in your local police department or sheriff s office? We can share information when investigating. What can you do to improve collaboration between law enforcement and MH providers? 53 54 9
Lori L. Yates A mental health consumer Licensed clinical social worker Consumer advocate Member of the steering committee A face and a voice for mental illness To educate others about mental illness. To provide hope. To teach how to work safely and effectively with mental illness. To work side by side with consumers. 55 Handout 56 We are people first! Talk to us, not over us or about us. We are not children. It is important that you really want to work with us. When faced with a professional who doesn t, we feel: - Anxiety - Fear We are likely to react out of a need to feel safe. 57 58 It is important that you remember that we did not ask to have a mental illness. Every day is a challenge to figure out. Life and everyone in it can pose a threat. Not all people with mental illness are violent! 59 60 10
We have a heightened awareness about others. Our inner experiences We are attuned to your body language, mood, tone of voice, attitude, smell, touch, and energy. 61 62 It takes time to make sense of things. We hear what you say even if we are not responding back to you: Sometimes our brains are slow to take things in; Sometimes too many people are talking at the same time; Sometimes we are afraid or embarrassed; Sometimes we are just being stubborn, or angry, or frustrated. Many people have had bad, if not traumatic experiences. Sometimes even a hint of negativity, frustration, sarcasm, or even joking around can trigger a serious reaction from us. 63 64 About treatment Receiving Services The nature of the illness is such that we really don t see, believe or understand that we are sick. Resistance is not always about not wanting treatment. Understand that it feels like we must fight for our lives. 65 66 11
About forced treatment About medication Many people are terrified about being committed. Some have truly had bad past, if not traumatic experiences. For some, being placed in treatment is a welcome relief. Sometimes it feels like a death sentence. Medications are not the silver bullet. In some cultures, medications are not readily accepted. 67 68 1. Treat us with kindness, dignity and respect. How you can help us 2. Don t give up on us. 3. Take time to really listen and hear what we say. 4. Stay honest when talking to us. 69 70 5. It makes a difference when the receptionist remembers our name. A warm smile goes a long way. Let the doctor or clinician know we are waiting. If there is a delay, let us know. 6. If you are a psychiatrist, know that we see you as the leader. 7. Take time to talk to the other members of the team who work with us. 8. Take time to listen to how we are doing and to acknowledge all that we are doing right. 9. Be patient with us over medications. 71 72 12
10. In times of crises: - Please have only one person talk at a time. - Give us time. - Don t run up to us like we are going to fight. 11. And use our expertise: We have a great deal to offer. Give us a chance to reconnect with you. 73 74 My life has completely changed because of a mental illness. Living takes on a whole new meaning. The work that you do is invaluable! www.loriyates.net Thank you for the opportunity to be the consumer voice for this training. Thank you! 75 76 13