www.monash.edu.au skills for working together for a safer community sally trembath hastings lyn...
TRANSCRIPT
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Skills for Working Together for a Safer Community
Sally Trembath HastingsLyn Waldron University Community Services
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Session Topics
• Guidelines• Mental Health Primer• Mental Health First Aid• Dealing with “Difficult People”• De-escalation Skills• Safety Plans
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Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour
1. Background
2. Objectives
3. Scope
4. Definitions
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5. Reasons for Threatening or Inappropriate Behaviour:
– Expressing emotion (usually anger or fear)
– Appealing for help– Attempting to intimidate others and control
their behaviour– To empower self
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
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– Staff, students, contractors & visitors– Heads of academic or administrative units,
supervisors– Faculties– Security– Monash Counselling services
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
6. Responsibilities:
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– when the person is in the room– when to involve couselling and/or security– when the incident is inappropriate or
threatening (mental health issue)– threats to self harm or suicide
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
7. How to Respond to Threatening or Inappropriate Behaviour:
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8. Follow-up ManagementStudents:
– General misconduct– Academic– Exclusion on health grounds
Staff:– Staff handbook– Contact Employee Relations & Consultancy
Branch
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
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9. Safety Plans
A co-ordinated response when disturbing behaviour is identified as ‘at risk’ to self or others and is ongoing:
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
–supports risk management–harm minimisation–early intervention–duty of care–Monash community wellbeing
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– a serious and imminent threat to an individual’s life, health, safety or welfare; or
– a serious threat to public health, public safety or public welfare.
11. University Support Services
Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.)
10. Confidentiality and Privacy
Monash University reasonably believes that the use or disclosure is necessary to lessen or prevent:
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Emotionally Disturbed People
Emotionally Disturbed Person
Mental Illness
Situational Stress
Medical Conditions
Substance Abuse
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A Mental Health Primer
• Schizophrenia and other psychotic disorders• Mood disorders
– Depression– Bipolar disorder
• Anxiety disorders – Acute anxiety– Generalised anxiety– Panic attacks– Phobias– Performance anxiety– P.T.S.D– O.C.D
Clinical Disorders
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Depression
– Depressed mood
– Loss of interest or pleasure
– Weight loss or gain
– Insomnia or hypersomnia nearly every day
– Observable hypermotor agitation or retardation
Depression is diagnosed when a patient has experienced a minimum of two weeks of:
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Depression (cont.)
– Fatigue or loss of energy
– Feelings of worthlessness
– Diminished ability to think or concentrate
– Indecisiveness
– Suicidal ideation with or without a plan
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Anxiety
– Abdominal discomfort– Diarrhoea– Dry mouth– Rapid heartbeat or palpitations– Tightness or pain in chest– Shortness of breath
The physical symptoms of anxiety are caused by the brain sending messages to parts of the body to prepare for the “fight or flight” response.
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Anxiety (cont.)
– Dizziness– Frequent urination– Difficulty swallowing– Insomnia– Irritability or anger– Inability to concentrate– Fear of madness– Feeling unreal and not in control of your
actions (depersonalisation)
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First Aid Strategies
1. Assess risk of harm to person or others.
2. Listen non-judgementally.
3. Give reassurance and information.
4. Encourage person to get appropriate professional help if needed.
5. Encourage self-help strategies.
The five steps in providing Mental Health First Aid are:
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How to Help Someone Going Through a Mental Health Crisis:
1. Introduce yourself and explain why you are present.2. Remain courteous and non-threatening, but be
honest and direct.3. Listen to the person in a non-judgemental way.4. Avoid confrontation at all costs – be prepared to
“agree to differ”.
•Suicidal•Anxiety attack•Acute stress reaction•Psychotic state, out of touch with reality
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Mental Health First Aid for Threats to Self-harm or Suicide - Monash Community
THREAT TO SELF-HARM OR SUICIDE
THREAT TO SELF-HARM OR SUICIDE
ASK HOW SERIOUSASK HOW SERIOUS
NO REASSURANCE = SERIOUS
NO REASSURANCE = SERIOUS
REASSURANCE = NOT SERIOUS
REASSURANCE = NOT SERIOUS
CALL COUNSELLING OR SECURITY
CALL COUNSELLING OR SECURITY
SUPPORT TO SOLVE IMMEDIATE ISSUE
SUPPORT TO SOLVE IMMEDIATE ISSUE
ASSIST COUNSELLING REFERRAL
ASSIST COUNSELLING REFERRAL
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3
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1
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• Do not get involved physically• Do not leave them alone• Seek immediate help:
– Phone the nearest hospital, who will provide appropriate crisis team number
– Phone Emergency 000– Take person to Emergency department of hospital– Take to General Practioner
• If consuming alcohol or drugs at that time, try and stop them.
Mental Health First Aid for Threats to Self-harm or Suicide – General Community
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• Try to ensure they do not have access to lethal means.
• Encourage them to talk. Listen non-judgementally. Do not deny the person’s feelings. Do not give advice beyond encouragement to get help.
• Give reassurance about this being a real medical condition and there are effective treatments for depression; and
• That the sooner they get help, the faster their depression will get better.
Mental Health First Aid for Threats to Self-harm or Suicide – General Community (cont.)
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Panic Attacks
1. The symptoms of a panic attack and a heart attack can be similar. If you do not know what is wrong, call the Health Service on ext. 53175.
2. If possible, help remove person to a quiet, safe place.
3. Help to calm the person by encouraging slow, relaxed breathing in unison with your own.
4. Be a good listener, without judging.
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5. If you know the person is having a panic attack and not a heart attack, reassure them with this information.
6. Explain that the attack will soon stop and they will recover fully.
7. Assure the person you will stay with them and keep them safe until the attack stops.
8. Encourage them to talk to a counsellor about strategies for managing panic attacks.
Adapted from Kitchener, B. & Jorm, A., Mental Health First Aid Manual (2002), Centre for Mental Health Research, The Australian National University.
Panic Attacks (cont.)
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Psychotic Behaviour
1. If someone is at risk of being hurt, call Security 333. Security will attend and call counselling or CAT team.
2. Do not approach person if it is unsafe to do so.
3. If you judge it safe, approach the person and introduce yourself, offering to help.
4. Stay calm and positive.
5. Remain respectful of the person.
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6. Do not try to manhandle them or force them to do anything in particular.
7. Listen to person and do not confront them or argue with them, even if they are saying irrational things.
8. Accept their reality.9. These experiences are often distressing.
Counselling staff can assist in the aftermath.
Psychotic Behaviour (cont.)
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Dealing with “Difficult People”:Understanding Anger
What is danger?Perceived• violation of rights• threat of loss• feeling powerless• treated with disrespect
What is anger?Neurochemical process which makes the body ready for fight against perceived danger.
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Dealing with “Difficult People”: Understanding Anger (cont.)
What does an angry person want?• acknowledgement• empathy and understanding• validation of feelings even if you disagree with
their perception• a solution• follow-up
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Dealing with “Difficult People”
– Continuously assess for danger– Maintain adequate personal space between you
and the person– Be calm– Give firm, clear directions
The person is probably already confused and may have trouble making even the simplest decision.
If possible only one person should talk to the person
Do:De-escalate
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Dealing with “Difficult People” (cont.)
– Respond to apparent feelings, rather than content (i.e. “you look/sound scared”);
– Respond to DELUSIONS and HALLUCINATIONS by talking about the person’s FEELINGS rather than what he is saying (i.e. “That sounds frightening,” “I can see why you are angry”)
Do:De-escalate
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Dealing with “Difficult People” (cont.)
– Be helpful In most cases, people will respond to questions
concerning their basic needs (e.g. safety). “What would make you feel safer/calmer?”
– Take a break – “time out”– Use distractions (e.g. ask for routine information)– Show of force if necessary
Do:De-escalate
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Dealing with “Difficult People” (cont.)
– Join into behaviour related to the person’s mental illness (e.g. agreeing/disagreeing with irrational/angry statements or thoughts)
– STARE at client - this may be interpreted as a threat
– CONFUSE the client – one person should interact with the client.
– GIVE MULTIPLE CHOICES – increases the person’s confusion
Don’t:Escalate
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Dealing with “Difficult People” (cont.)
– WHISPER, JOKE, or LAUGH Increases the person’s suspiciousness with
potential for violence– DECEIVE the person
Being dishonest (or patronizing) increases fear and suspicion; the person will likely discover the dishonesty and remember it in any subsequent contacts
Don’t:Escalate
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Dealing with “Difficult People” (cont.)
– TOUCH the person Although touching can be helpful to some people
who are upset, for others it can increase anxiety, elicit fear, and could lead to violence
Don’t:Escalate
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High Risk Situation
• Maintain position of safety• Notify someone to request security• Confine and isolate the situation• Avoid rapid actions• Remain calm• Be aware of environment• Note entrances and exits• Observe person’s body language
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High Risk Situation (cont.)
• Separate people who are in conflict• Move dangerous objects out of
reach/view of client• Remove people/objects that upset client• Utilize people/objects that have positive
effect on client• Do not violate client’s personal space
– Move slowly, if necessary, and explain actions
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Effective Communication Skills: Encouraging Response
• Calm, direct instructions• Simple acknowledgements• General leads• Broad openings in questions or comments• Seek clarification• Positive use of authority: not patronising or
controlling
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Effective Communication Skills: Encouraging Response (cont.)
• Keep client talking• Stress positives• Remain objective• Discuss alternatives• Convey respect and attentiveness• Be an active listener
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Effective Communication Skills: Asking Questions
• Simple and direct• Open ended• Seek reasons for client’s actions• Focus on “healthy” aspects of client• Be honest• Develop rapport
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Communication to Avoid
• Do not use analogies – be concrete• Do not challenge delusions• Do not be manipulated• Do not legalise• Do not over react to language or gestures
aimed at you• Do not order, command, warn, or threaten• Do not moralise• Do not name call or ridicule
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Responding to Threatening or Inappropriate Behaviour
Threatening or inappropriate behaviour in a face to face situation
Safe to pursue the conversation Not Safe to pursue the conversation
Ask person to leaveDe-escalate*
Doesn’t leave – call security
Person leaves
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Responding to Threatening or Inappropriate Behaviour (cont.)
Record incident and inform appropriate staff and departments
Decide on follow-up – in consultation with Security if needed
Consider disciplinary action (Faculty/Division) Utilise
OHSC, Equity and Diversity Policies.
Discuss protocol for further incidents with all
relevant staff and departments
Refer threatener to UniversityCounselling Service for Assessment or Referral
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A Safety Plan
Step 1
Identify “At risk” Person
At risk behaviour
Compliant or non compliant
Accepting of treatment
If compliant the person can give permission for other parties to be consulted. It is prudent to have them sign a release of confidential information document.
Non Accepting of treatment
If at risk person is non compliant it is important to be aware of confidentiality and privacy legislation.
Monash University reasonably believes that the use or disclosure is necessary to lessen or prevent
a serious and imminent threat to an individual’s life, health, safety or welfare; or a serious threat to public health, public safety, or public welfare.
Privacy Officer 56011
A protocol for providing a co-ordinated and containing response when disturbing behaviour is identified as being “at risk’ to self or others and is on going.
Supports risk managementHarm minimisationEarly interventionDuty of CareMonash community wellbeing
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A Safety Plan (cont.)
Step 2
Identify Stakeholders
Stakeholders may include some of:
Faculty StaffAcademicGeneralSecurityUniversity Community ServicesHealth ServiceCounsellingMonash InternationalExternal Mental Health ProvidersPsychiatristsForensic ServicesCAT teamsDeputy University SolicitorDLUFamily and Social Networks
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A Safety Plan (cont.)
Step 3
Develop Safety Plan
Stakeholders meet to develop an informed co-ordinated approach to support student and staff dealing with the situation
To Develop a Safety plan
a. Consult with peers to collect information and understand the situationb. Decide on the course of actionc. Call a meeting of stakeholders
Meeting of Stakeholders
a. Appoint a co-ordinator and lines of reportingb. Identify triggers to behaviourc. Consider optionsd. Timing of interventione. Document plan, record events, witness statements etcf. Define roles of stakeholdersg. Schedule feedback to stakeholders
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QuestionsQuestions