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Every year, my hospital requires me to complete training in the management of patient aggression. This is particularly good training to have for anyone working with forensic patients. Sometimes, I have to work with patients who are dangerous or angry for a variety of reasons, and frontline staff like nurses, nursing aides, and security attendants are particularly at risk for patient assault.
The training covers topics like basic self-defense techniques, “take-down” and escort procedures, and both individual and environmental causes of patient violence. Of course, the most important teaching point is that communication skills and verbal de-escalation are the most crucial tools in the violence prevention toolbox.
I had an opportunity to appreciate these skills recently when a local “citizen journalist” and blogger was involved in a prolonged standoff with police. He was wanted for a violation of probation and for failure to appear in court. Several hours before the warrant was served, he tweeted that he was a “bad bad” and “dangerous” man, and he put up a blog post suggesting that his life would be short and that he would “die free.” Unknown to police, there was also a weapon with ammunition in the home.
What made this situation unusual was the fact that the blogger in question had his own Internet-based radio show, a large Twitter following and a chat room hosted on his website. When police arrived to serve the warrant, he refused to come out of the house, and the standoff began. The blogger recorded his conversation with the police negotiator and broadcast it in real time through the Internet. The conversation lasted close to 2 1/2 hours, and drew listeners from around the world. At one point as many as 8000 people listened, and many more joined in through Twitter and the chat room. I was able to follow this conversation and the public response to it.
While both the negotiator and the defendant had clear moments of tension and frustration, I was impressed overall by the level of calm rationality demonstrated on both sides. Here are a few de-escalation teaching points I came away with: The defendant was preoccupied with past grievances and injustices involving the police. He felt unfairly targeted, and thought the presence of the SWAT team was excessive and unnecessary. He had many complaints about the local police department’s response to crime in general and his past experience in the local detention center.
The negotiator allowed him time to list and discuss past events in detail, and expressed appreciation for this information. He frequently emphasized the need to resolve the standoff in order to move beyond the past. This emphasis upon the future implicitly suggested that recovery was possible and that the situation was not a catastrophe.
In addition, the negotiator admitted any problems with miscommunication or misunderstanding and gave the defendant an opportunity to clarify his statements. He encouraged the defendant to continue the conversation and didn’t press for early resolution. He emphasized points of agreement, particularly the fact that neither side wanted a bad outcome. He recognized and specifically commented on the defendant’s skills, strengths, and experience. He used humor judiciously, and overlooked insults and degrading comments.
Public comment throughout the standoff showed the effectiveness of these interventions. Early in the standoff, there was general sentiment that the defendant was being treated unfairly or disproportionately, but as time passed this opinion changed. Tweeters questioned his motives for prolonging the standoff, suggested that he was grandstanding to build his following and also questioned his judgment. A few directly called on the defendant to come out and give himself up, which he did eventually.
Shortly before coming out the defendant himself complimented the negotiator, and they were able to share a brief joke. When the defendant said he was going to “wrap this (broadcast) up in time for the networks” the negotiator lent a hand by adding, “To our listeners … thank you for listening.”
This event illustrates that although health care professionals and police obviously have different roles, priorities, and duties, safety is a priority for both, and there are skills we can learn from each other.
—Annette Hanson, M.D.
DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.
Every year, my hospital requires me to complete training in the management of patient aggression. This is particularly good training to have for anyone working with forensic patients. Sometimes, I have to work with patients who are dangerous or angry for a variety of reasons, and frontline staff like nurses, nursing aides, and security attendants are particularly at risk for patient assault.
The training covers topics like basic self-defense techniques, “take-down” and escort procedures, and both individual and environmental causes of patient violence. Of course, the most important teaching point is that communication skills and verbal de-escalation are the most crucial tools in the violence prevention toolbox.
I had an opportunity to appreciate these skills recently when a local “citizen journalist” and blogger was involved in a prolonged standoff with police. He was wanted for a violation of probation and for failure to appear in court. Several hours before the warrant was served, he tweeted that he was a “bad bad” and “dangerous” man, and he put up a blog post suggesting that his life would be short and that he would “die free.” Unknown to police, there was also a weapon with ammunition in the home.
What made this situation unusual was the fact that the blogger in question had his own Internet-based radio show, a large Twitter following and a chat room hosted on his website. When police arrived to serve the warrant, he refused to come out of the house, and the standoff began. The blogger recorded his conversation with the police negotiator and broadcast it in real time through the Internet. The conversation lasted close to 2 1/2 hours, and drew listeners from around the world. At one point as many as 8000 people listened, and many more joined in through Twitter and the chat room. I was able to follow this conversation and the public response to it.
While both the negotiator and the defendant had clear moments of tension and frustration, I was impressed overall by the level of calm rationality demonstrated on both sides. Here are a few de-escalation teaching points I came away with: The defendant was preoccupied with past grievances and injustices involving the police. He felt unfairly targeted, and thought the presence of the SWAT team was excessive and unnecessary. He had many complaints about the local police department’s response to crime in general and his past experience in the local detention center.
The negotiator allowed him time to list and discuss past events in detail, and expressed appreciation for this information. He frequently emphasized the need to resolve the standoff in order to move beyond the past. This emphasis upon the future implicitly suggested that recovery was possible and that the situation was not a catastrophe.
In addition, the negotiator admitted any problems with miscommunication or misunderstanding and gave the defendant an opportunity to clarify his statements. He encouraged the defendant to continue the conversation and didn’t press for early resolution. He emphasized points of agreement, particularly the fact that neither side wanted a bad outcome. He recognized and specifically commented on the defendant’s skills, strengths, and experience. He used humor judiciously, and overlooked insults and degrading comments.
Public comment throughout the standoff showed the effectiveness of these interventions. Early in the standoff, there was general sentiment that the defendant was being treated unfairly or disproportionately, but as time passed this opinion changed. Tweeters questioned his motives for prolonging the standoff, suggested that he was grandstanding to build his following and also questioned his judgment. A few directly called on the defendant to come out and give himself up, which he did eventually.
Shortly before coming out the defendant himself complimented the negotiator, and they were able to share a brief joke. When the defendant said he was going to “wrap this (broadcast) up in time for the networks” the negotiator lent a hand by adding, “To our listeners … thank you for listening.”
This event illustrates that although health care professionals and police obviously have different roles, priorities, and duties, safety is a priority for both, and there are skills we can learn from each other.
—Annette Hanson, M.D.
DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.
Every year, my hospital requires me to complete training in the management of patient aggression. This is particularly good training to have for anyone working with forensic patients. Sometimes, I have to work with patients who are dangerous or angry for a variety of reasons, and frontline staff like nurses, nursing aides, and security attendants are particularly at risk for patient assault.
The training covers topics like basic self-defense techniques, “take-down” and escort procedures, and both individual and environmental causes of patient violence. Of course, the most important teaching point is that communication skills and verbal de-escalation are the most crucial tools in the violence prevention toolbox.
I had an opportunity to appreciate these skills recently when a local “citizen journalist” and blogger was involved in a prolonged standoff with police. He was wanted for a violation of probation and for failure to appear in court. Several hours before the warrant was served, he tweeted that he was a “bad bad” and “dangerous” man, and he put up a blog post suggesting that his life would be short and that he would “die free.” Unknown to police, there was also a weapon with ammunition in the home.
What made this situation unusual was the fact that the blogger in question had his own Internet-based radio show, a large Twitter following and a chat room hosted on his website. When police arrived to serve the warrant, he refused to come out of the house, and the standoff began. The blogger recorded his conversation with the police negotiator and broadcast it in real time through the Internet. The conversation lasted close to 2 1/2 hours, and drew listeners from around the world. At one point as many as 8000 people listened, and many more joined in through Twitter and the chat room. I was able to follow this conversation and the public response to it.
While both the negotiator and the defendant had clear moments of tension and frustration, I was impressed overall by the level of calm rationality demonstrated on both sides. Here are a few de-escalation teaching points I came away with: The defendant was preoccupied with past grievances and injustices involving the police. He felt unfairly targeted, and thought the presence of the SWAT team was excessive and unnecessary. He had many complaints about the local police department’s response to crime in general and his past experience in the local detention center.
The negotiator allowed him time to list and discuss past events in detail, and expressed appreciation for this information. He frequently emphasized the need to resolve the standoff in order to move beyond the past. This emphasis upon the future implicitly suggested that recovery was possible and that the situation was not a catastrophe.
In addition, the negotiator admitted any problems with miscommunication or misunderstanding and gave the defendant an opportunity to clarify his statements. He encouraged the defendant to continue the conversation and didn’t press for early resolution. He emphasized points of agreement, particularly the fact that neither side wanted a bad outcome. He recognized and specifically commented on the defendant’s skills, strengths, and experience. He used humor judiciously, and overlooked insults and degrading comments.
Public comment throughout the standoff showed the effectiveness of these interventions. Early in the standoff, there was general sentiment that the defendant was being treated unfairly or disproportionately, but as time passed this opinion changed. Tweeters questioned his motives for prolonging the standoff, suggested that he was grandstanding to build his following and also questioned his judgment. A few directly called on the defendant to come out and give himself up, which he did eventually.
Shortly before coming out the defendant himself complimented the negotiator, and they were able to share a brief joke. When the defendant said he was going to “wrap this (broadcast) up in time for the networks” the negotiator lent a hand by adding, “To our listeners … thank you for listening.”
This event illustrates that although health care professionals and police obviously have different roles, priorities, and duties, safety is a priority for both, and there are skills we can learn from each other.
—Annette Hanson, M.D.
DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.