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Janet Eppard, M.S.N., R.N.
Rescue Mental Health Services
3350 Collingwood Blvd.
Toledo, Ohio 43610
(419) 255-9585
Crisis care settings have a high potential for violence, There are many factors which attribute to increased violence in these settings, including the extreme stress that many individuals are experiencing when they present for help related to a precipitating event, their higher incidence of drug and alcohol abuse, and concomitant stressors such as homelessness, unemployment, and criminal charges. Also, individuals presenting for crisis care often carry primary diagnosis of mental illnesses that have been demonstrated to increase violence potential.
Dealing with violence in the crisis care setting does impact on services. The clinician must be alert to the potential by continually doing a risk assessment. Many factors are considered in a violence assessment, including history of violence, diagnosis, substance abuse, demographic characteristics and history of exposure to domestic violence. Assuring safety is important not only to the staff and other clients and family members who may be visiting, but to the individual at risk. Assuring the ability to maintain safety often diffuses the situation and enables a therapeutic alliance to develop.
Administrative initiatives that can increase safety and control violent episodes within a crisis care setting have been implemented at Rescue Mental Health Services. First, it is important to establish and maintain positive relationships with local police departments, thus assuring a timely response to any call for aid. A safety alert directory that identifies individuals with a history of violence within the organization can speed appropriate clinical response and prevent a violent outburst, but needs careful quality monitoring. Staff training should emphasize non-violent interventions and strategies aimed at assisting the individual to gain control and to diffuse volatility. Debriefing after an incident is an effective training tool, and also assists those staff involved to regain composure and confidence in returning to the therapeutic milieu. These are issues and strategies that will be discussed