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.

1. Providing important and sometimes critical information with regards to an employee’s present mental state and psychological functioning.
2. Estimating what the employee’s future psychological functioning will be like in a variety of situations and circumstances.
3. Suggesting alternatives and options.
4. Assisting in developing a response plan.
5. 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:

1. 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.
2. 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.
3. 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:

1. 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.
2. 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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