Personal Safety in Interviewing

(Taken from Managing Mental Disorders, WHO, 2000)

The most important factor when dealing with a potentially violent individual is to maintain personal safety at all times. The following tips are important for enhancing personal safety.

Never turn your back on the individual A violent outburst can occur in a split second. Continuous observation of the individual is imperative but avoid direct eye contact. Don't walk ahead of the individual and stand at least a punch distance away. Consider personal safety at all times.

Let the patient talk Avoid interrupting the patient. If an interruption is necessary ensure that it is done quietly and calmly.

Ensure a safe escape route. The environment of the community centre is extremely important in terms of minimising violence. Many experts recommend that, in the interview room, the individual should remain closest to the door. However, there is apparently no consensus on this topic. Generally, unless violence is premeditated or goal-directed, the distressed individual would rather escape than fight. Violence oiften occurs because the individual feels threatened, cornered, and not in control. By providing the individual with a safe escape route (i.e., an unobstructed exit), you minimise the chance of a violent outburst. If the individual feels cornered or has trouble finding an exit, his or her aggression levels are likely to rise and innocent bystanders may become the object of the individual's frustration. Other experts argue that the clinician should remain nearest the door so that he or she can escape if the individual becomes violent. Ideally, both the individual and the clinician would have equal access to a safe exit, preferably separate exits. If this set-up is not possible then it is recommended that the clinician remains nearest to the exit, or that the interview room door is left open, or that the room has an observation panel that allows a clear view from, say, the secretary's desk outside.

Structuring the environment In addition to the provision of safe escape routes, other environmental factors can minimise violence and increase safety during actual or impending violent outbursts. It is important that interview rooms and reception desks have a discreet buzzer or intercom that can be used to summon immediate help when needed. It is also preferable if other staff members are clearly visible or at least seen to pass by the room at frequent intervals so as to deter violence and to provide help if needed. Forewarn other staff to be nearby and available if there is a chance of aggressive behaviour. If help is required, predetermined code words may be spoken to obtain this assistance with minimum fuss (e.g., "Kate, can you get Mr Simpson's red file for me please?").

Also, interview rooms should have externally locking doors to ensure that help cannot be locked out and that the individual can be locked in if necessary. Doors should preferably be kept open during interviews so that the individual does not feel trapped and so that help is easily visible and available. However, confidentiality issues also need to be considered.

Look for anger Look for signs such as a red face, rising voice, focussing/narrowing of gaze, and tensing of muscles.

Don't be a hero Do not try to handle a violent individual on your own. Get help from anywhere you can, leave the room, or ask the individual to leave. Think SAFETY FIRST.

Weapons NEVER try to disarm an individual who has a weapon. If the individual claims to have a weapon, take his or her word for it and GET OUT.

If you suspect that the individual has a weapon, GET OUT. If you cannot keep the individual in safe seclusion, GET OUT of the room or building.

Make sure that other staff and waiting patients are informed and escorted to a place of safety such as another room or another building. Call security or the police immediately.

PREVENTINGAND MANAGING VIOLENT OUTBURSTS

By recognising signs of impending violence early in the interview it may be possible to defuse it before the individual loses control. The following strategies may be useful for this purpose. If one strategy does not appear to work or is clearly inappropriate, go on to the next strategy. It will be important to constantly monitor the individual's responses and to adopt different strategies accordingly. If you cannot escape stay calm. Try to get help if possible. Do not wrestle with the aggressor. Adopt a passive and non-threatening body posture (e.g., hands by side with empty palms facing forward, body at 45' angle to aggressor, minimise eye contact).

Be observant. Be prepared for rapid self-protection if necessary.

Obey the individual's instructions and try not to upset him or her. Generally it is recommended that 'hostages' do not speak unless spoken to. However, it is also suggested that it is better to keep the individual speaking rather than acting. Therefore, the best option may be to speak as little as is required to keep the individual speaking or preoccupied and not acting. If the individual starts to calm down a little and the timing is appropriate, it may be possible to suggest that the individual puts the weapon on the table or in another safe place. If the individual agrees, do NOT attempt to grab the weapon but rather play for time until help arrives. If help cannot be notified, talk empathically with the individual in order to continue to defuse the situation. However, do not agree with ludicrous delusions. It may help to say something such as, "I can see you're upset by this belief Maybe it's true, maybe it's not.

Use surrounding objects and furniture as shields if violence occurs.

Escape if a safe opportunity arises. It must be emphasised here that there is no single way to react and that the clinician should use his or her expertise to choose the most appropriate plan of action. The main point to remember though is: do not wrestle or argue with the aggressor.

Remove'dangerous' clothing. Scissors, knives, or any other unnecessary objects that can be picked up and thrown (e.g., glass ashtrays) should not be kept in the interview room. Intentional or unintentional injury may occur if a violent individual catches hold of various items of clothing. Some items of clothing that may need to be removed prior to interviewing a potentially violent individual include: glasses; earrings; necklaces; other pieces ofjewellery; neckties; pens or pencils (from pockets); and cigarette lighters.