How do you get used to working with violent people?

[forobviousreasonsanon]

I work in inpatient psychiatry; very small case load but very specialised and intense. We take step downs from intensive care, prison etc, although not classed as forensic or secure.

How do you get used to credible threats of violence? I know the worst response is to look scared but I can’t always help it!

This is my first job, I’m newly qualified. Even the verbal is draining at times, it’s just continuously being called a c**t or being told to fuck off.

I’m fully trained in break away and interventions, we have medications, alarms, locked doors etc so very very safe - but it’s still a bit scary.

The background stuff is exhausting too, lots of background reports trying to work out why this happens and it’s never pleasant. People never come to us with a simple background. It’s fascinating but it’s just exhausting sometimes. Dealing with people who’ve committed sexual offences etc.

Today has been a v, v long day, we don’t formally debrief and I’m just so bloody tired.. Does it get easier?

fuck me hats off to so so many of you above with experiences and great advice. I couldn’t do your jobs and I’m in awe of you. I go to pieces at any conflict so I’m so grateful people out there like you guys exist

I don't have any advice but was listening to the first of the Reith lectures earlier today- they are around violence and might be an interesting listen www.bbc.co.uk/programmes/b00729d9

Sorry for another post but your post really resonates with me back when I was newly qualified and scared senseless at times, and I wish I had someone I could talk to who had been there without judgement.

Being scared is a normal reaction don’t beat yourself up if you appear scared! But I also promise that your “poker face” will come, being calm in this type of situation is a skill and to put it in ordinary terms, you wouldn’t expect to pick a guitar up and instantly be able to play, it’s the same here, practice, practice, practice .

Not really the same but I work with teens with SEND and they can really struggle with regulation and as a result can be violent or aggressive, maybe not the level you’re dealing with but colleagues have had their noses broken, wrists broken, I’ve been driving a minibus and a child has smashed a window and ripped a chair clean out whilst moving (obv I pulled over), they can also be violent with one another in shaded spaces. I’ve had ‘I’ll kill you you bitch’ screamed literally screamed in my face while brandishing a stick and pulling me by the hair, the same kid 30 mins later was laughing with me about Pokémon and asking me for Jam on toast. The only thing I’d say is try not to be too blasé about things, some staff I work with have been doing it for 20 years and with some any ‘show of weakness’ from newer staff is laughed at, but the ones who are truly good at their jobs and best With the children are the ones who are supportive and ask if you are ok, if you feel unsupported or under minded then speak up. The only other thing I’d say is that with time you just sort of do become desensitised which isn’t a great thing as your empathy can dwindle too. Find someone at work you can really trust and lean on them if you can, we all sort of have our ‘work besties’ and help each other out. If your work environment ain’t great you’re not going to be able to cope with the demands of the job no matter how amazing you are

@ThisWarmQuoter agree so much with you, with each situation you learn something whether you’ve been there 6 months or 16 years, everyone is learning never beat yourself up just try your best and try and learn from everything

I was in the Prison Service for years, you get used to it after a while and learn to let the threats go over your head, it becomes a part of your daily routine.

@KindLemur I remember a mentor who was 30 years on in the job when I was young fresh, naive 😂and 18 years old saying to me, “the moment I say I no longer have anything to learn is the moment I need to retire” it’s always resonated with me since then which was many many moons ago!

Op always put yourselves first and keep yourself safe. Dont think that you have to deal with xyz because other staff members do. The patients can be very aware of any vulnerabilities. And unfortunately management can put targets ahead of staff happiness

I go by the adage “Don’t take criticism from anyone you wouldn’t take advice from”. The people I work with can say and do whatever they want and it doesn’t get to me because I wouldn’t want to be in their position if that makes sense. It comes from an empathetic perspective I think. Working with violence does make you a bit twitchy though, it can be difficult to switch off. My hairdresser always comments that I have very tense shoulders.

That's really interesting.

@ThisWarmQuoter I remember one of my first days, a colleague told me that a child she was taking out on a extra curricular that day was very upset because they had not been allowed to take an item with them they wanted (for whatever reason), and they’d said to her ‘you and your kids deserve to die you fucking terrorist’ … I was aghast that she was sort of chuckling about this like they’d told her her hair looked silly or something, or they didn’t like her coat. Anyway two years later I came across her doing an activity with the same child, and I said to her later ‘are you two pals now?!’ And she said that the child had apologised almost 2 years later ! And said they just said it because it was shocking. Sums it up really. Never take it personally. Even if they never apologise I just always think ‘they probably won’t even remember saying this, so it can’t mean much’. As someone said above try and see it all as communicating int he only way they can. So hard sometimes though ! Especially on an already hard day.

You get immune to it, even the suicide attempts, you become very practical and think fast. You have to approach things to the situation for example using a monotone voice might patronise or make some people think you’re not taking them seriously, but in others it might work. I had people leave after a month and two after their first shift!

As someone said, it’s not personal, people are ill, or scared and are reacting or lashing out in a fight or flight mode. If you don’t take it personally you are better equipped to assist.

This should have been dealt with in your physical intervention training?
Any decent training (including breakaway/disengagement) should include a decent amount of theory, such as de-escalation and relational security.
I'm not sure why you say "not forensic" when people with criminal convictions are the definition of forensic in this context?
Are you getting appropriate training and support?
If you're expected to complete assessments for such complex individuals (HCR-20s for example) I'm concerned that it sounds like you've been left floundering.

Good team work is absolutely essential, communication and following robust work routines handover, reporting, daily notes etc

I too am interested in what area you work in as sounds like forensic

and agree when something feels wrong step away, often you need to just listen not give opinions/advice or try to reason

John Wayne walk
pulling weights is a good way to work off the stress of the job

I'm a mental health nurse, but in the community and I work with older adults so the threat is significantly less.

Regardless working in mental health is just very draining and thankless sometimes, and the paperwork never ends, so solidarity. You do amazing work OP, it's hard anyway without the additional threat of having to worry about bodily harm.

That’s really interesting

A number from our team are being diagnosed I am not surprised

I too stay calm in emergencies

I'll also add that it does get easier. You'll be surprised at what you get used to. Suicidality, self-harm, delusions, hallucinations, etc which all sounds shocking to others become your norm. You also grow in confidence a lot. I was a nervous wreck when I qualified, but they're sink or swim jobs and the vast majority do swim.

Communication is your most important tool, and watching for early warning signs of violence, then trying to use non-contact forms of de-escalation first.

It's easy to burn out working in your setting OP, so make the most of friends/hobbies on your days off and really try and forget work and rest. If you're ever feeling like you've lost compassion or you dread it, move on

I used to work in a cat b male prison. I managed by pretending not to be scared, I used to walk down the wings and be saying in my head act like you don't care. It kinda became normal to the point where I didn't care. I look back and I do wonder what I was doing but it helped me. Walk like your confident, they smell weakness op. Inwas a drug worker and would walk around the prison, I had a set of keys etc

I found martial arts training helpful.
Certainly desensitised me to violence. Also meant I had a fair idea what to do if protocols failed.
I never used it. Ever. Words and body language are a lot better.

Karate for me. Having a sense of discipline and control over your body and your reactions helps a lot, particularly being able to overcome your own very natural fight or flight response when feeling threatened.

And find a way to debrief - which is really about discharging your feelings and physical response rather than necessarily talking situations through, important thought that can be. For me it was loud singing in the car on the way home, physically shaking the day off, changing clothes, maybe having a shower, journaling (writing my thoughts and feelings, not about the specific incidents or people I was working with). I also had a sensory pack in my desk with nice scented hand cream, strong mints, some blue tac (for squishing), a set of worry beads to fidget with. Basically things that engaged all my senses to help regulate my system.

It’s hard but learning what works for you is part of the job, you need to actively attend to yourself otherwise you’ll burn out.

Agree with this. I don’t particularly like confrontation (strange choice for a job!) and used to become slightly breathless and my legs would shake when it became apparent that something was about to kick off physically even if I didn’t feel especially in danger. Your body responds to alert messages in other people’s body language and behaviour by flooding you with adrenaline fight or flight style and you have to learn and understand your own responses before you can get it under control. Karate will teach you about this, a martial art be handy to help you feel more confident mentally as well as physically.

I have Schizoaffective disorder, very very occasionally when very unwell have got very angry & agitated.
I would say definitely do not touch the person to try to comfort them! eg on one occasion I was in a state of feeling suicidal and someone tried to put her hand on my arm which made me instantly feel like I was going to hit them, I actually didn't but pulled away & said firmly please don't touch me.)

Telling an agitated person to 'calm down' is a very bad idea.

Telling a manic person to stop talking is not good either, a student CPN did that to me once, he didn't understand that you can't help but talk too much.

When I'm well I have a part time job on a surgical ward.
I've cared for people in delirium due to the effects of surgery / anaesthetic etc.

We used to have no security and the porters would come as they were 'security trained' apparently.
But I saw them escalate bad situations by making too much eye contact & 'squaring up' to patients in an aggressive way; also some other staff have shouted at confused or aggressive patients which winds them up more.
Pick your battles: One aggressive man just wanted his tea made with a fresh teabag rather than from the ward hosts' brewed teapot. It would've taken seconds but the ward host spent longer refusing to make it fresh & the patient then kicked off unsurprisingly.