Friday, July 25, 2014

Gunslinger Shrinks

Psychiatry isn't one of the safest of medical specialties, neither is psychotherapy. We've had the case, several years ago, in New York City in 2008, where a psychologist and a psychiatrist were both attacked by an irate, probably psychotic former patient. The psychologist got the worst of the attack and she hadn't even been his former therapist, the psychiatrist had treated him. But they shared office space and she, unfortunately, was the one who offered him a seat while he waited for the psychiatrist to see him. For her kindness she was attacked viciously and died. The psychiatrist, who came to her aid, was also attacked but survived and the former patient has now had his insanity plea rejected.

Having worked in a number of psychiatric settings, I have not only heard stories of attacks by patients, but of the unusual measures mental health professionals have taken to try to protect themselves from harm. One psychiatrist, after having a woman suddenly pull a gun out of her handbag after she came into his office, made one rule: no handbags or bags of any kind in his office. I have no idea whether he also made a rule against large coats, also.

While I was on a hospital unit, a patient passed me in the hall, smiled and wished me a good day. I had no idea the patient was on her way to assault the psychiatrist. Neither did I notice the large pocketbook she carried which contained a very heavy holy book. Once inside the office, she pulled the book out, sprung over the desk and began beating the physician with it. Only the psychiatrist's loud screams alerted ward staff to rush to her defense.

As it was in the recent shooting death of a psychiatric case worker in Pennsylvania,  there were no alarm devices, buzzers or video cameras to monitor activity on the ward or in the offices. Only years later were cameras placed at the outside entrances to the buildings. These cameras were little protection since patients learned quickly how effective shaving cream can be used against their watchful eyes.

On the same unit while I was there, a nurse was cornered in a chart room with a heavy door that, once shut, muffled most sound. She was beaten viciously by a patient and only managed to escape death through the actions of another nurse who wondered why the door was shut, it was a dutch door. Her injuries meant the end of her career in psychiatric nursing and she left soon after her sick leave was over.

Another nurse in a psychiatric hospital in another state was killed because she refused to give a patient a cigarette. These are only the ones I heard about, although I did know a psychologist who was attacked in a hospital stairwell (infamous for attacks since they have locked doors at both ends) where he had his shirt ripped and his glasses broken before he could free himself.

Psychiatric emergency departments, or so I've heard, are one of the least desirable places to work. I did work for a brief time on the admissions unit of a psychiatric hospital, but I had plenty of protection. Patients usually came strapped to gurneys or in handcuffs compliments of the local police and one stayed with me as I completed the interviews.

There are certain precautions anyone in mental health should take and, in fact, anyone in situations which may involve heated discussions and they are:

1. Never sit away from the door

2. Never keep any heavy items, pencils or pens on your desk. This includes picture frames, Pet Rocks or ashtrays/receptacles of any type. So, keep your desk as clear as possible.

3. Always alert someone that you're meeting with a specific person and where you'll be

4. Don't sit on the other side of a table from someone. Tables are great for being pushed and trapping you against a wall. Notice how all those TV cop shows set up the interrogation rooms? Good idea.

5. No pocketbooks, knapsacks, book bags, shopping bags, etc. may be brought into the room.

6. Heavy winter coats or jackets must be left outside.

There's no guarantee that these rules will always be useful, but it's good to keep them in mind, especially when you're dealing with anyone who may have unusual stress in their lives. Preparation is your best defense against any sudden move toward you.

The question that arises from the Pennsylvania shooting is whether or not it's a good idea for medical personnel to carry weapons. It's my understanding that the facility in question did not permit it and there will be arguments on both sides here. Some will say the physician's gun prevented more blood shed and others won't agree.