Training: coping with the threat of violence

A convicted sex offender was jailed for life last month for the murder of his disabled fiancée and her care worker at a one-bedroom flat in Southampton in March. He lived with the body of his dead fianceé for eight days before murdering Sarah Merritt, 39, when she arrived to look after her.

The case is an extreme one. According to British Crime Survey figures from 2003-5, health and social welfare staff have a 2.5% chance of being attacked or threatened, compared with a 9.7% chance for prison officers or a 4.6% chance for agricultural managers. But health and social care staff still came fifth in the danger league table, and the murder case above illustrates the vulnerability of social care workers, particularly those who work alone in the community.

Sector training body Skills for Care insists that dealing with dangerous behaviour is a key part of social work training. But trainer Iain Bourne, who runs courses on dealing with dangerous behaviour and formerly worked in adolescent mental health, says social workers tell him they have not been given enough training in the area. One team he trained felt so under threat they were demanding stab vests.

The government took the issue seriously enough in 2001 to launch a £2m campaign to reduce violence and abuse against social workers by 25% by March 2005. Unfortunately, when March 2005 came round, the government was unable to confirm whether the target had been met because it had no central records on attacks against social workers.

Risk goes with the territory, says Social Care Association chief executive Nick Johnson. That element of risk will never be removed completely, “particularly if you’re imposing services on people who don’t want them, such as child protection or statutory mental health”, he adds.

British Association of Social Workers chief executive Ian Johnston agrees: “Social workers have to go into situations to protect children, so you can’t just say ‘I’m not going, I’m not dealing with these people’.”

Because social care staff will never be able to completely avoid difficult situations, the emphasis must be on reducing risk.

One council that has been picked out for its strategy in this area is West Lothian Council in Scotland. The Health and Safety Executive, in its literature on work-related violence, highlights the council’s approach to protecting its social workers and personal care staff.

The council runs training courses, delivered by the police or personal safety charity the Suzy Lamplugh Trust, on avoiding potentially violent situations, developing coping methods and minimising risk, for example by parking cars facing the road to allow a quick getaway.

The council is also developing a simple flowchart so staff know how to report different types of incidents.

Personal alarms are available on loan and a mobile phone lone worker system has been set up, where workers leave a message on a central computer with the details of their visit. If they do not ring back at the expected time an alert is activated at reception, where staff will eventually contact the police if they cannot contact the worker.

The council is pleased with the impact these measures have had overall, but some have been less successful than others. Self-defence training, requested by some staff, is not encouraged as it can lead to an escalation of violence and requires regular practice and refresher training. Similarly, mobile phones are rarely useful when someone is being attacked, and the lone worker mobile phone system requires a 24-hour reception.

The council’s head of social policy, Grahame Blair, says the technology that interests him most is a shared information system that draws together records from health, social services, housing and sometimes police, so that all the information or alerts about a service user are displayed on one screen.

If workers are worried about a particular client they can ask for an out-of-hours meeting to take place at a police station, and new social workers will have a “protected caseload” to allow them to avoid confrontational clients. Some of the more difficult cases will be handled by new “principal social workers”, who will be the most experienced practitioners.

Unison’s assistant national health and safety officer, Vincent Borg, says the key to staying safe is how risk assessments are carried out. Staff cannot make a valid risk assessment if they have not been trained to make one or lack the relevant background information about clients.

And Borg sounds a note of caution about the use of technology. If you know the situation is going to be or could be violent, you don’t send people into that situation, regardless of the technology they are equipped with, he says. If there is a potential risk, clients should be asked to attend a centre to receive the service, or workers should attend appointments in pairs, before the issue of technology or emergency mobile phones comes up.

“Technology shouldn’t be relied upon as if ‘that’s the problem dealt with – you can now go out and visit violent clients’,” he says. “I’ve heard good and bad reports from members about these systems. If your phone is snatched away from you, what then? If you make a call and the person is aware of that, will that make them more violent?”

Borg has also heard reports of incidents where security systems did not help the social worker. He says: “There’s a place for them, but it’s a last resort to deal with unforeseen circumstances. “We wouldn’t want employers seeing them as a panacea to deal with violence and lone working.”

TOP TIPS
IAIN BOURNE, Trainer
Staying safe

● Trust your gut reactions – if a situation feels wrong, it probably is. Take a step back. If visiting a client, try calling them on your mobile first to check it’s still OK. If the visit really is so important that it can’t be done at a later stage, then the police or an ambulance should be there as well.
● When in danger, the only professional responsibility is to get yourself out safely – not to complete your social work task.
● The more dangerous the situation feels, the less you should do – but you should do something. Often just repeating the client’s name or saying “wait” can be enough – it may slow the aggressor down, help them save face, and stop you from having to think of something clever (but probably toxic) to say. Keep it very, very simple.
● You are properly trained as “reflective practitioners”, but when dealing with dangerous behaviour, you need to learn how to be a “safe reactive practitioner”.
● Always make sure that your organisation has a robust, sincere and active staff safety policy – and that you, your colleagues and managers follow it.

Learn to cope through training

Should all the safety protocols, protective technology and good practice seem insufficient, there is always the course billed as “training with a touch of terror”.

“If I’d been invited to this course, I wouldn’t attend,” warns trainer Iain Bourne as he begins the session, organised by charity Homeless Link. “If you think you’re going to spend the day looking at an overhead projector you’re sadly mistaken. This course is like a nightmare.”

However nightmarish it is, the course has a practical aim – to give staff who might face dangerous situations a taste of the fear they would experience, and strategies for coping with it. The centrepiece of the course is a role-play in which Bourne plays a convincing “dysphoric” individual whose aggressive behaviour is driven by uncontained emotional rage.

After setting out a back story in which participants must imagine themselves in the position of a community-based worker visiting a client in his flat, Bourne bursts into the room in costume with his face drenched in sweat. Course participants sitting in the front row must remain in their seats for their own safety as Bourne screams and waves a kitchen knife in their faces.

The best response would be to leave the flat. But in this scenario the worker is sitting down and the client is blocking the exit. Even from my position of relative safety in the back row the representation is real enough that I feel the adrenalin freezing me in my seat. It is this potentially lethal freezing of mind and body that the course teaches you to recognise and, it is hoped, overcome.

The key, according to Bourne, is breathing out to free the body from its paralysis and letting the thalamus part of the brain, which has evolved to deal with danger, take control rather than the cortex, the thinking part of the brain.

To make sure you breathe out, Bourne suggests simply repeating a single-syllable word, which you have already rehearsed in your head, such as “wait” or “stop”. As well as preventing your body from shutting down, this stops you from having to think of what to say next.

It can also help to fill the “vacuum” in a disturbed attacker’s head, in which he does not know what to do next and may just fill the gap with violence. Broadcasting your actions, by saying things such as “I’m getting up now” helps to make them predictable. And showing the attacker that you are frightened lets them know their message has been received, allowing them to save face. Different responses are needed for dealing with dangerous psychosis, including narrowing the focus of the potential attacker and speaking loudly and continuously to interrupt auditory command hallucinations.

Course details at www.homeless.org.uk or www.dangerousbehaviour.com  

CASE STUDY
PAUL BAIN
Community leader, Emmaus Cambridge
Held at knifepoint by drunk resident

Paul Bain, community leader at homelessness project Emmaus Cambridge, knows all about dangerous situations. The former police officer was held at knifepoint by a furious and intoxicated project resident for two hours.

The situation began when two residents at the project, which is drug and alcohol-free, went into town and started drinking. The two men fought on the way back from town, and this led to one of them bursting into the community’s kitchen in the early hours to find a knife to attack the other.

Bain appeared on the scene just as this man, who had a history of violence, was about to track down his companion. Bain decided he could not let him out of the room to confront the other resident. The result was that the first man held the knife to Bain’s stomach as he tried to talk him down. “I spent a lot of time saying ‘this is scaring me’ and eventually it got through, but equally I was not going to move. It was just a case of talking to him, reiterating things again and again.”

Eventually Bain managed to convince the man to sit down with him, but the knife remained pointed at him. “It takes a long time, and you’re thinking ‘I could end up being quite hurt here’.

“This guy I dealt with – it was pure rage. There was still some sense there, but he was so angry. You still had the ability to speak with him, reason with him. It took a long time but it [the reason] was still there.”

Bain relied on the good relationship he had formed with the man, and his police experience, which helped him to deal with the adrenalin produced by fear without panicking. “If you keep a calm persona, then you stand more chance.”

Eventually he did calm the resident down, and got him back to his room to eat and sleep. The next morning, the man was asked to leave the project.

But Bain adds that he only felt confident enough to confront the resident because of his experience in the police. “It is very easy to say I did this and that, [but] it could quite easily have gone the other way.”

Related articles
Knives, guns, gangs: The effort to counter the spread of weapons carrying by young people is gathering pace. We visit Leeds

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

A client heard voices that he should stab Nigel Leaney. Then, during a sleep-in, a kitchen knife appeared under his bedroom door

Further information
Skills for Care
Social Care Association
BASW

Contact the author
 Simeon Brody

This article appeared in the 12 July issue under the headline “It’s OK to be frightened…”

This weeks other feature articles:

Voice’s Blueprint project: children in care have their say
Disabled people: accommodation wrangle puts paid to independence