Dealing with violent service users. Jim Wild on how a national strategy is needed

The article explores the difficulties and dilemmas associated with circumstances where workers need to impose their authority when users are difficult, evasive or dangerous. As a way of illustrating the complexities the author discusses a situation faced by one social worker.

The use of real life scenarios in training would help social workers regain some measure of control with intimidating service users. A national protocol would also help, writes Jim Wild

Several years ago a social worker and I collaborated on a risk assessment on a man amid severe concerns that he might harm children living with him.

The worker described his first meeting. The man invited the social worker into the kitchen. As he sat down at the kitchen table the man took a carving knife from a draw and also sat down at the table, placing the knife on the table. There was no doubt this action was meant to intimidate the social worker.

I was shocked by this. What, I asked, did he do? The social worker said he continued with the interview as if the knife was not there. This “meeting” between the worker and service user had vast implications for an equitable relationship, inevitably ruptured and distorted into a range of fears and uncertainties for the social worker whenever there was a need to explore difficulties.

This form of intimidation is rarely discussed in teams for whom monitoring of children’s health and well-being is seen as a task requiring minimal contact because of unwilling users. Indeed, when facilitating training on dangerous, difficult or evasive users, delegates invariably talk about how ill-equipped they feel. Verifying children are safe and well forms part of complex and anxiety-provoking interactions with adults who can indicate there could be dire consequences if a worker goes “too far” in their inquiries.

The case of “Child B”, the disabled child who suffered terrible abuse at the hands of her parents is an example where professionals made numerous visits, but on one occasion (when the child had suffered serious injury) the parents explained she had been taken out by relatives. For whatever reason, workers did not ask if they could verify this by looking around the house. Similarly, there were critical moments before Victoria Climbié’s death, when social workers were given evasive responses by her great aunt and boyfriend.

It can be difficult, particularly for the inexperienced worker, when legitimate attempts are made to impose authority, because they cause practitioners anxiety about being too oppressive or accusatory. Central to these intricate negotiations is our knowledge of previous serious injuries and fatalities. It is on these occasions where a subtle array of skills are needed but which are rarely taught in mandatory training for front-line staff.

I developed the knife incident in a training exercise where I provided a fictional scenario attempting to replicate the social worker’s experience. The group sit in a circle slightly removed from a dramatic “backdrop” hosted around a kitchen table where volunteers play the social worker, the male user, but also a terrified child “clinging” to the user. As the knife is placed on the table each member of the group is requested to write down “in the instant” what they would say and what they are thinking.

This request produces similar answers each time the exercise is undertaken:

●”I would ignore the knife.”
●”I would ask what the knife is for.”
●”I would ask for the knife to be removed.”
●”I’d say I’m leaving unless the knife is removed.”
●”I would make any excuse and leave.”

What is remarkable about the responses is that most social workers will attempt to engage the user when power relations are not only stacked against them, but their commitment to “continuing regardless” puts them at serious risk. Workers often think they are failing if they desert a situation such as the knife scenario they also (more likely) just don’t really know what to do and see the best strategy as being to tread water and hope they are alive at the end of the interview.

In busy teams, managers can easily forget what it is like to face unacceptable stress. This allows potentially life-threatening behaviour to become routine: “By remaining silent about improper behaviour we help normalise it, enhancing its perpetuation by implicitly encouraging potential offenders to regard it as morally acceptable.”(1)

Having delivered this exercise to more than 500 delegates around the UK over five years, several critical issues emerge. There are:

●No continuity or national staff procedures.
●Little preparatory work undertaken to “rehearse” these scenarios in training environments which create authentic enactments.
●A lack of managerial support.
●Limited willingness to update and develop procedures and training.

Often, managers commission training on dangerous users only when there has been a serious incident. This reactive behaviour signals a lack of care for front-line staff. Indeed, such is the lack of confidence workers have in support systems that many do not disclose threatening behaviour and somehow muddle through the mess of angry, hostile or evasive users.(2)

There seems to be a vital and fundamental need for consistency so a clear message is given to users when they threaten or intimidate workers. There is also a need each year to revise and update with research informing good practice, co-ordinated by a national body. The cost of such a scheme would be minimal when we consider the benefits to front-line staff.

These matters cannot be left to individual services to implement but must be part of a rigid process where all staff across the country are party to an overlapping procedure which has at its heart a sense of care for all staff who sometimes feel like they work in a war zone. Sleepless nights would be replaced by support.

So is there a “model” answer to the knife exercise? Well I think there is. As soon as you see the knife you create a bogus and totally innocuous reason for your call. You then depart on good terms. You co-ordinate an immediate visit with the police and a fellow social worker. The user may be angry. You stand your ground and state that when he put the knife on the table any opportunity for discussion was over and you decided to leave and obtain back up. You explain you are not prepared to be intimidated. The child and female partner (who in real life were terrified of this man) see you can control him.

However, it’s worth then thinking through the above actions because a conundrum emerges – to undertake the above action do you have the support of your line manager? Do you have the sort of relationship with the police that you could undertake such action? Do you have enough confidence in yourself to be able to take this action?

Jim Wild was a practitioner in safeguarding work for more than 15 years. He now convenes the first Unit for Critical Studies in Men and Masculinities at Nottingham Trent University and is also course leader for the first qualification in applied studies in working with men.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

References
(1) E Zerubavel, The Elephant in the Room: Silence and Denial in Everyday Life, Oxford University Press, 2006
(2) J Stanley, C Goddard, In the Firing Line: Violence and Power in Child Protection, Wiley, 2002

This article appeared in the 12 April issue under the headline “Stand your ground”

This weeks other feature articles:
The moral and ethical debate over the voluntary sector’s acceptance of public money for services. Mark Ivory guides

Staff tell us their contrasting tales of working in the voluntary sector viz a viz the statutory sector

The challenges involved in GPs commissioning social services

The Department of Health wants a radical shake-up of commissioning health and social care services. Barbara Allen and Elizabeth Wade assess the potential of its new framework