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Professional News
Published Online: 6 October 2006

How to Stay Safe in Your Office

Publication: Psychiatric News
Volume 41, Number 19
https://doi.org/10.1176/pn.41.19.0007
Many psychiatrists practice with the possibility of encountering patients who are violent. However, clinicians can take steps to reduce the risk of harm.
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Obtain a thorough history, including history of violence or interaction with law enforcement, to help identify potentially violent patients and use a standardized risk assessment tool, such as the MacArthur Community Violence Interview used in NIMH's CATIE study.
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Be aware that previous violence and/or substance abuse are the most significant predictors of future violence.
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Share your assessment of patients' risk of violence with them. Ask patients to estimate their risk of violence and discuss the issue fully.
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Foster impulse control through setting strong limits on patient behavior and offer acceptable alternatives to inappropriate behaviors.
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In private offices in homes or office buildings, foster a more secure physical environment:
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Remove objects that could become weapons.
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Install office doors with windows to allow monitoring of sessions.
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Ensure more than one escape route from your office.
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Install a panic button to summon help.
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Never see patients who have a history of violence or paranoia or who are borderline with little impulse control in a home-office setting or in a private office suite when no support staff are immediately available. A more secure setting is indicated, such as a hospital ER or a community mental health clinic that has security staff.
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When confronted with an imminent threat of violence, use clinical skills to de-escalate the situation.
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If you are physically attacked by a patient who has no weapon and are unable to escape or summon support/security staff immediately, a good strategy is to “clinch” or employ the “bear hug.”
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If attacked, you must actively defend yourself; under these circumstances, self-defense must take priority over Hippocrates' admonition to “first, do no harm.”
Adapted from Carl Bell, M.D., “Psychiatric Aspects of Violence: Issues in Prevention and Treatment,” New Directions in Mental Health Services, summer 2000.

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Psychiatric News
Volume 41 • Number 19 • October 6, 2006
Pages: 7

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Published online: 6 October 2006
Published in print: October 6, 2006

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