The Mental Health Provider and Workplace Violence Prevention
January 2004
An experienced mental health provider can
make a valuable contribution to the Workplace Violence Prevention Team as it
manages potentially violent workplace incidents. An employee assistant provider,
psychologist, psychiatrist, or other mental health professional can help round-out
the Team.
by James
N. Madero, Ph.D.
Violence Prevention
International
Workplace Violence Prevention Programs have been a part of many of America’s
businesses and organizations for over a decade. The “best practice” programs
generally include a workplace violence prevention policy, a workplace violence
prevention team, training for every employee, a violence vulnerability audit,
incident reporting, investigation and response processes, methods for dealing
with difficult employees, and procedures for terminating a potentially violent
employee.
At the heart of a comprehensive Workplace Violence Prevention Program is
the Workplace Violence Prevention Team. While the membership of this team can
vary from organization to organization, most teams usually have members from
human resources, security, legal, and executive management. These members respond
to and manage the incidents that are reported to the Workplace Violence Prevention
Team. Some teams include a mental health professional. The contributions of
the mental health professional will be the focus of this article.
The Depressed Security Guard
Consider this example. Bill M. worked as a security guard at an airport in
a large city in the Midwest. Three months after the start of his employment,
he went on a disability leave that lasted 6 weeks. He then submitted a note
from his doctor that stated he was ready to return to work. Bill’s supervisor,
the chief of security, enjoyed having Bill as an employee, but was reluctant
to have him return to work. The chief of security couldn’t put his finger on
it, but something didn’t seem right about Bill’s returning to work. The chief
of security discussed his concerns with his human resources manager, and they
decided to have Bill take a fitness-for-duty evaluation. Bill was referred to
a clinical psychologist who specializes in workplace violence prevention.
The psychologist interviewed Bill and gave him a series of psychological
tests. Among the results of the evaluation were the following.
- Bill has a 10-year history of experiencing a serious depression every
2 to 3 years.
- While out on disability, he entered an inpatient hospital program for
depression.
- Prior to entering the hospital, he seriously considered committing suicide
by shooting himself with the gun he was given when he became a security
guard.
- He was recently discharged from the program, and his doctor said he
was ready to return to work.
- Bill was still moderately depressed and prone to future episodes of
depression and suicidal thoughts.
Once Bill signed a Release of Information, the psychologist discussed the
results of the evaluation with the security director and the human resources
manager. They subsequently met with Bill to discuss his return to work. They
all agreed that working as a security guard with a weapon was not in Bill’s
or his employer’s best interests. They worked out a transfer to a less stressful
job in another department. Bill was pleased with the transfer and has performed
very well in his new job.
An Important Contribution
The above vignette demonstrates the important role a mental health professional
can play in a Workplace Violence Prevention Program. The psychologist who evaluated
Bill was able to tell the chief of security and the human resources manager
that there was some risk in having Bill continue to work as a security guard.
Individuals who are depressed sometimes respond to situations in a slower manner
than those who are not depressed. Since Bill’s work as a security guard might
at some point require a very rapid response, he could be placing himself and
or others at risk if he delayed responding even for a second or two. In addition,
it did not seem prudent to provide Bill with a gun, considering his suicidal
thoughts.
The mental health evaluator is able to contribute to the work of the Workplace
Violence Prevention Team in a number of ways. Among these are the following.
- Providing important and sometimes critical information with regards
to an employee’s present mental state and psychological functioning.
- Estimating what the employee’s future psychological functioning will
be like in a variety of situations and circumstances.
- Suggesting alternatives and options.
- Assisting in developing a response plan.
- Helping manage a workplace violence incident to a safe and effective
conclusion.
Selecting the Right Professional
There are at least three choices available with regard to selecting a mental
health professional as a member of the Workplace Violence Prevention Team. They
are outlined below.
- Employee Assistance Provider. This is
a mental health professional who is part of an Employee Assistance Program
(EAP) and who could, under some circumstances, perform the work described
in the above vignette. These circumstances would include a willingness to
do the work and sufficient background and training to perform fitness-for-duty
evaluations and manage workplace violence incidents. However, some EAP providers
are reluctant to perform fitness-for-duty evaluations or any similar activity
that could result in making a potentially negative recommendation with regard
to a worker’s employment. EAP providers typically perceive themselves as
functioning as an employee advocate, and therefore may be reluctant to place
themselves in any situation that would force them to not be an advocate.
There are also EAP providers who may not have been trained in the area of
workplace violence prevention, and therefore do not have sufficient experience
in evaluating and/or managing workplace violence incidents. It would be
a disservice to the EAP provider, the employee, and the employer to ask
the EAP provider to practice beyond their level of training and experience.
- Clinical/Forensic Psychologist. Most clinical
and forensic psychologists are trained and have experience in conducting
mental status examinations and performing psychological evaluations of individuals
with a variety of psychological problems and disorders. This experience
is an important and essential component of evaluating the level of risk
an employee might have with regard to a workplace violence incident.
- Psychiatrist/Forensic Psychiatrist. Most
psychiatrists and forensic psychiatrists are trained and have experience
in conducting mental status examinations, diagnosing psychological problems
and disorders, and evaluating the level of risk a person may present to
others or him/herself. Psychiatrists usually do not do extensive psychological
testing. Instead they are likely to refer the testing to a psychologist.
Whether an EAP provider, psychologist, psychiatrist, or other mental health
professional is involved with the Workplace Violence Prevention Team, the following
selection criteria are recommended.
- A willingness to do the work.
- Training and experience in evaluating and treating individuals with
a variety of psychological problems and disorders.
- Sufficient training and expertise in the field of workplace violence
prevention.
- The ability to do fitness-for-duty evaluations, threat assessment evaluations,
and homicidal/suicidal risk evaluations.
When To Evaluate
One of the more challenging decisions that sometimes confronts members of
a Workplace Violence Prevention Team as they manage an incident is when to send
an employee for a fitness-for-duty evaluation or a psychological/psychiatric
evaluation and when not to send the employee. Generally, a referral for an evaluation
is recommended when:
- There is a low level of risk involved both to the evaluator and the
employer. The evaluation should be conducted without the employee who is
being evaluated becoming angry to the point of engaging in potentially destructive
behavior.
- The employee’s employment is likely to continue. If the decision has
already been made to end the employment relationship, or if there is a very
high probability that such a decision will be made, then usually an evaluation
is not recommended. To ask an employee to spend from 4 to 8 hours talking
to, and being tested by, a mental health professional, only to then be terminated,
is risking the very real possibility that the employee will act out aggressively
because the employee feels he or she has been treated very unfairly.
- There is an attempt to reach out and help the employee. There are many
instances when the preference/recommendation of the Workplace Violence Prevention
Team is to continue employment and work with the employee on whatever issues/problems
triggered the incident at hand. An evaluation can then serve as a tool to
assist the Workplace Violence Prevention Team in the development of a remedial
plan for the employee.
The decision not to make a referral for an evaluation is recommended when:
- There is a high level of risk either to the evaluator, the employer,
coworkers, or some individual(s). A risk-benefit analysis is usually conducted
by the Workplace Violence Prevention Team. When the risk of violence is
considerable and outweighs the benefits of an evaluation, then the evaluation
is generally not recommended.
- The employment relationship is likely to be ended. As noted above, if
the decision to terminate the employee has already been made, or is likely
to be made, then an evaluation is usually not recommended unless there are
compelling reasons to do so, and the risks can be reasonably managed.
A Final Note
Hopefully the above discussion has brought into focus the contributions that
an experienced mental health provider can bring to the Workplace Violence Prevention
Team as it manages potentially violent workplace incidents. The efforts of businesses
and organizations over the past 10 years to reduce workplace violence seem to
be working. In the early 1990s the U.S. Department of Labor’s Bureau of Labor
Statistics reported over 1,000 workplace homicides per year. For the past several
years, there have been less than 650 workplace homicides. The concept of utilizing
a team approach to dealing with workplace violence has most likely played an
important role in this reduction.
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