# Presentation: 258560

## Managing Violent Students

- Pacific-Western Region
- Health and Wellness Managers’ Conference
- May 2004  Seattle, WA
- Andrew Berger, Ph.D
- Regional Mental Health Consultant

## Main Topics

- Danger To Self
- Danger To Others
- Reasonable Accommodation On Center

## Who is Dangerous?

- Psychotic Disorders
-       hallucinations
-       paranoia
-       loss of reality
-       delusions
-       talking to self
-       magical thinking

## Drug or Alcohol Use 

- Decreases Inhibitions or Impulse Control
- Exacerbates Anger or Depression
- Exacerbates  Psychosis

## Problem Drugs

- Alcohol—Increases Dangerousness
- Methamphetamine—Can cause paranoia and violence
- PCP—paranoia, violence, superstrength

## Antisocial Personality Disorder

- Most Violent
- No Remorse
- No Empathy
- Self-Centered
- Inability To Take Responsibility
- Manipulative
- Charismatic and Charming

## Antisocial Behavior

- Appear Very Social
- Prone to Drug and Alcohol Abuse
- Unable to Hold a Job
- Multiple Sexual Relationships
- Living “On The Edge”—high risk behavior
- Angers Easily
- No Relationship Bonding

## Antisocial Personality

- Most Dangerous
- Fills State Prisons
- Usually Lifelong, Chronic and Enduring
- May Have Biological and Familial Components
- Some Have Mental Health Complaints
- Easily “Institutionalized”

## Violence and Mental Health

- People With Mental Health Problems Less Likely To Be Violent Than General Population
- Reclusive
- Fearful
- Passive
- In Own World

## Evaluating Potential Violence

- History
- Recency of Violence
- Psychosis
- Drug or Alcohol Intoxication
- Antisocial Tendencies
- Threats—Including Poetry
- Agitation—Challenging Behavior

## Contending With Violence

- Calm the Trainee—speak softly, reflect understanding of feelings, show empathy, make eye contact
- Keep Distance Between You and Student-Keep exits available
- Call for help--get others involved

## More Anti-Violence Measures

- Set Limits—Violent people will often respond to structure—discuss consequences
- Monitor level of agitation, assess for changes
- Encourage Trainee to Warn You of Violence—develop a dialogue about violence and contracts for no violence

## Violence Precautions

- Get others involved--Mental Health  Counselors, Administration
- When In Doubt, Separate Trainee
- Call Police-Do not hesitate to get help—will not “worsen situation” as many fear—will calm and contain violent trainee
- Violent in the morning, likely violent in the afternoon.  It doesn’t just go away.

## Suicide Risk

- Depression, Psychosis or Personality Disorder—may suicide by mistake
- Poetry
- Non-Compliance with Medication
- History
- Recency
- Drug or Alcohol Abuse
- Recent Loss—breakup with boyfriend

## Response To Suicide

- Develop Dialogue—talking helps
- Myth—talking about suicide increases likelihood of suicide
- Take poetry and threats seriously
- Get 72 hour involuntary hold evaluation
- Do Not Leave Student Alone
- Obtain History and level of hopelessness

## More Suicide Procedures

- Alert Mental Health
- Get Others Involved—Case Management
- Call Police If Student Uncooperative
- Consider MSWR—even if temporarily doing better
- No Suicide Precautions—We are not a hospital
- MSWR requirements Before Return JC

## No Imminent Suicidality

- Implement a Plan:  There Must Be Follow-Up—Multidisciplinary  Case Management—Use PCDP
- HIPPA Allows Sharing of Information on an as needed basis.  Do not hold information “hostage”
- Urgent Medication Evaluation--R/O Non-compliance with meds
- Suicide Contracts Alone Do Not Work

## CSO/SPO and Mental Health

- Must Work As A Team
- Behavioral Contracts When Lack of Compliance—especially medications
- Non-Compliant Trainees Still Responsible for Appropriate Behavior On Center
- May Have Disciplinary Separations for Non-Compliance

## Summary

- Mentally ill Less Violent
- Mentally ill more likely suicidal
- Develop Dialogue
- Be Conservative—Take Action
- Get Other Disciplines Involved--HIPAA