Clinical Psychiatry News posted “Tips for avoiding potentially dangerous patients” on 8-10-17. This article discusses a presentation by Jeffrey Younggren, PhD and Ernest Bordini, PhD at the 2017 Annual Convention of the American psychological Association.  Dr. Younggren served as a risk management consultant for the APA Insurance Trust for 18 years. In his presentation, he critiqued an APA article on safety and offered his own recommendations, which, given his extensive experience are worth considering.

He disagrees some of the APA recommendations, such as not working alone at night, installing security cameras, and learning self-defense techniques. His recommended self-defense technique: “fall on the ground.” He focuses more on preventing exposure to danger than self-defense in the moment of danger. For example, he recommends a physical awareness of exit options, a strict rule about not seeing inebriated patients, and promptly, but respectfully, terminating any patient who threatens you.

Dr. Bordini noted that psychiatric patients are more likely to be the victims of violence than to be perpetrators, but also disputes the idea that all psychiatric patients do not have elevated risk for aggressive behavior. He recommends being more careful when working with patients who have psychotic or bipolar disorders, particularly if they experience delusional or obsessive thoughts about the therapist. And, he questioned Dr. Younggren’s “playing possum” defensive strategy and instead recommended focusing on de-escalation strategies, maintaining an escape plan, and practicing your plan, when possible, in order to be ready when needing to execute your plan under stress.

MHConcierge’s take: Some clinicians will work with populations with more of a risk  of aggression, and will need to have a safety plan in place. Obviously, you hope that it will not be necessary, but on the other hand it could be crucial to be prepared, even for a rare event.

The full article is available for free online.


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