Crisis

Dealing With A Potentially Violent Person

Virginia J. Duffy PhD, Psychiatric Nurse Practitioner

It is very difficult to predict violence in any particular person. The best we can hope for is to recognize the potential risk by using factors that we know are correlated with violence. The patient's history is the most important information to have when trying to assess risk of violence. It is critical to obtain as much information, as quickly as possible, regarding the person who is threatening violence. Someone who knows how to assess the threat level and possesses the skills to communicate effectively should take the lead in talking with the potentially violent person.

Risk Factors for Violence

It is important to note that a mental illness diagnosis does not necessarily increase the risk of violence, although the presence of command hallucinations and/or paranoid delusions does.

•  Males under the age of 30

•  Previous history of violence including domestic violence is the most reliable predictor of current threat level.

•  Victim or witness to childhood violence

•  Record of criminal behavior

•  Social isolation/exclusion

•  History of substance abuse

•  Working class

•  Low income

•  Low assertiveness

•  Low education level

•  Impulsivity

•  Unstable family, social situation

•  Brain injury

•  Low intelligence

Immediate Risk Factors for Violence

•  Verbal threat of immediate harm to a specific individual, particularly a significant other

•  The further in the future and the less specific, the lower the risk, ("I'm going home and kill her now," vs." Someday someone will pay for this").

•  Under the influence of alcohol or drugs

•  Access to the means to carry out the threat.

•  Command hallucinations (voices telling the person to kill someone)

•  Agitation/yelling/use of profanity

•  Pacing

•  Getting in "your face"

How to Prevent Violence

Violence cannot always be prevented but we can reduce the risk by using some of the following techniques. Prevention is the best accomplished by dealing with angry and potentially violent people early when problems arise. Waiting till it reaches a crisis level is the most dangerous thing to do.

In dealing with angry or potentially violent persons empathy is the most effective communication tool to use. It helps to diffuse anger and deescalate the situation.

The most important consideration in dealing with someone who is threatening violence is your safety, the safety of the person being threatened, the safety of bystanders and finally the safety of the violent person.

What to Say and Do

•  Remove the means for violence whenever possible.

•  Keep sentences short, repeat if needed and use a minimum amount of words.

•  Stay at a safe distance.

•  One person should speak at a time, keep lookers to a minimum

•  Talk slowly in a quiet, calm voice.

•  Maintain a calm, non-threatening environment. Reduce noise, lights, unnecessary people and stimuli.

•  Listen and ask for clarification of the patient's statements.

What Not to Say and Do

•  Do not joke.

•  Do not talk too much.

•  Do not have more than one person talking to the person at a time.

•  Do not talk too loud or too fast.

•  Do not overwhelm the person with stimuli.

•  Do not touch the person or get too close.

•  Do not make quick moves or reach into pockets.

•  Do not interpret what the patient is saying, or jump to conclusions.

•  Do not be judgmental; try to understand the persons point of view.

•  Do not reply to verbal challenges.

•  Avoid debate and confrontation.

Empathy is the most effective communication tool to calm and angry person, diffuse anger and prevent violence. Learning how to use empathy and make empathic statements should be a goal of anyone who works with the public

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