Skills for Working Together for a Safer Community

1. Skills for Working Together for a Safer Community Sally Trembath HastingsLyn Waldron University Community Services

2. Session Topics • Guidelines • Mental Health Primer • Mental Health First Aid • Dealing with “Difficult People” • De-escalation Skills • Safety Plans

3. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour • Background • Objectives • Scope • Definitions

4. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 5. Reasons for Threatening or Inappropriate Behaviour: • Expressing emotion (usually anger or fear) • Appealing for help • Attempting to intimidate others and control their behaviour • To empower self

5. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 6. Responsibilities: • Staff, students, contractors & visitors • Heads of academic or administrative units, supervisors • Faculties • Security • Monash Counselling services

6. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 7. How to Respond to Threatening or Inappropriate Behaviour: • when the person is in the room • when to involve couselling and/or security • when the incident is inappropriate or threatening (mental health issue) • threats to self harm or suicide

7. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 8. Follow-up Management Students: • General misconduct • Academic • Exclusion on health grounds Staff: • Staff handbook • Contact Employee Relations & Consultancy Branch

8. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 9. Safety Plans A co-ordinated response when disturbing behaviour is identified as ‘at risk’ to self or others and is ongoing: • supports risk management • harm minimisation • early intervention • duty of care • Monash community wellbeing

9. Working Together for a Safer Community:Guidelines for Responding to Threatening or Inappropriate Behaviour (cont.) 10. Confidentiality and Privacy Monash University reasonably believes that the use or disclosure is necessary to lessen or prevent: • a serious and imminent threat to an individual’s life, health, safety or welfare; or • a serious threat to public health, public safety or public welfare. 11. University Support Services

10. Substance Abuse Mental Illness Emotionally Disturbed Person Situational Stress Medical Conditions Emotionally Disturbed People

11. A Mental Health Primer Clinical Disorders • Schizophrenia and other psychotic disorders • Mood disorders • Depression • Bipolar disorder • Anxiety disorders • Acute anxiety • Generalised anxiety • Panic attacks • Phobias • Performance anxiety • P.T.S.D • O.C.D

12. Depression Depression is diagnosed when a patient has experienced a minimum of two weeks of: • Depressed mood • Loss of interest or pleasure • Weight loss or gain • Insomnia or hypersomnia nearly every day • Observable hypermotor agitation or retardation

13. Depression (cont.) • Fatigue or loss of energy • Feelings of worthlessness • Diminished ability to think or concentrate • Indecisiveness • Suicidal ideation with or without a plan

14. Anxiety The physical symptoms of anxiety are caused by the brain sending messages to parts of the body to prepare for the “fight or flight” response. • Abdominal discomfort • Diarrhoea • Dry mouth • Rapid heartbeat or palpitations • Tightness or pain in chest • Shortness of breath

15. Anxiety (cont.) • Dizziness • Frequent urination • Difficulty swallowing • Insomnia • Irritability or anger • Inability to concentrate • Fear of madness • Feeling unreal and not in control of your actions (depersonalisation)

16. First Aid Strategies The five steps in providing Mental Health First Aid are: • Assess risk of harm to person or others. • Listen non-judgementally. • Give reassurance and information. • Encourage person to get appropriate professional help if needed. • Encourage self-help strategies.

17. How to Help Someone Going Through a Mental Health Crisis: • Suicidal • Anxiety attack • Acute stress reaction • Psychotic state, out of touch with reality • Introduce yourself and explain why you are present. • Remain courteous and non-threatening, but be honest and direct. • Listen to the person in a non-judgemental way. • Avoid confrontation at all costs – be prepared to “agree to differ”.

18. THREAT TO SELF-HARM OR SUICIDE 1 ASK HOW SERIOUS 2 NO REASSURANCE = SERIOUS 3 REASSURANCE = NOT SERIOUS 5 CALL COUNSELLING OR SECURITY 4 SUPPORT TO SOLVE IMMEDIATE ISSUE 6 ASSIST COUNSELLING REFERRAL 7 Mental Health First Aid for Threats to Self-harm or Suicide - Monash Community

19. Mental Health First Aid for Threats to Self-harm or Suicide – General Community • Do not get involved physically • Do not leave them alone • Seek immediate help: • Phone the nearest hospital, who will provide appropriate crisis team number • Phone Emergency 000 • Take person to Emergency department of hospital • Take to General Practioner • If consuming alcohol or drugs at that time, try and stop them.

20. Mental Health First Aid for Threats to Self-harm or Suicide – General Community (cont.) • Try to ensure they do not have access to lethal means. • Encourage them to talk. Listen non-judgementally. Do not deny the person’s feelings. Do not give advice beyond encouragement to get help. • Give reassurance about this being a real medical condition and there are effective treatments for depression; and • That the sooner they get help, the faster their depression will get better.

21. Panic Attacks • The symptoms of a panic attack and a heart attack can be similar. If you do not know what is wrong, call the Health Service on ext. 53175. • If possible, help remove person to a quiet, safe place. • Help to calm the person by encouraging slow, relaxed breathing in unison with your own. • Be a good listener, without judging.

22. Panic Attacks (cont.) • If you know the person is having a panic attack and not a heart attack, reassure them with this information. • Explain that the attack will soon stop and they will recover fully. • Assure the person you will stay with them and keep them safe until the attack stops. • Encourage them to talk to a counsellor about strategies for managing panic attacks. Adapted from Kitchener, B. & Jorm, A., Mental Health First Aid Manual (2002), Centre for Mental Health Research, The Australian National University.

23. Psychotic Behaviour • If someone is at risk of being hurt, call Security 333. Security will attend and call counselling or CAT team. • Do not approach person if it is unsafe to do so. • If you judge it safe, approach the person and introduce yourself, offering to help. • Stay calm and positive. • Remain respectful of the person.

24. Psychotic Behaviour (cont.) • Do not try to manhandle them or force them to do anything in particular. • Listen to person and do not confront them or argue with them, even if they are saying irrational things. • Accept their reality. • These experiences are often distressing. Counselling staff can assist in the aftermath.

25. Dealing with “Difficult People”:Understanding Anger What is anger? Neurochemical process which makes the body ready for fight against perceived danger. What is danger? Perceived • violation of rights • threat of loss • feeling powerless • treated with disrespect

26. Dealing with “Difficult People”: Understanding Anger (cont.) What does an angry person want? • acknowledgement • empathy and understanding • validation of feelings even if you disagree with their perception • a solution • follow-up

27. Dealing with “Difficult People” Do: De-escalate • Continuously assess for danger • Maintain adequate personal space between you and the person • Be calm • Give firm, clear directions • The person is probably already confused and may have trouble making even the simplest decision. • If possible only one person should talk to the person

28. Dealing with “Difficult People” (cont.) Do: De-escalate • Respond to apparent feelings, rather than content (i.e. “you look/sound scared”); • Respond to DELUSIONS and HALLUCINATIONS by talking about the person’s FEELINGS rather than what he is saying (i.e. “That sounds frightening,” “I can see why you are angry”)

29. Dealing with “Difficult People” (cont.) Do: De-escalate • Be helpful • In most cases, people will respond to questions concerning their basic needs (e.g. safety). “What would make you feel safer/calmer?” • Take a break – “time out” • Use distractions (e.g. ask for routine information) • Show of force if necessary

30. Dealing with “Difficult People” (cont.) Don’t: Escalate • Join into behaviour related to the person’s mental illness (e.g. agreeing/disagreeing with irrational/angry statements or thoughts) • STARE at client - this may be interpreted as a threat • CONFUSE the client – one person should interact with the client. • GIVE MULTIPLE CHOICES – increases the person’s confusion

31. Dealing with “Difficult People” (cont.) Don’t: Escalate • WHISPER, JOKE, or LAUGH • Increases the person’s suspiciousness with potential for violence • DECEIVE the person • Being dishonest (or patronizing) increases fear and suspicion; the person will likely discover the dishonesty and remember it in any subsequent contacts

32. Dealing with “Difficult People” (cont.) Don’t: Escalate • TOUCH the person • Although touching can be helpful to some people who are upset, for others it can increase anxiety, elicit fear, and could lead to violence

33. High Risk Situation • Maintain position of safety • Notify someone to request security • Confine and isolate the situation • Avoid rapid actions • Remain calm • Be aware of environment • Note entrances and exits • Observe person’s body language

34. High Risk Situation (cont.) • Separate people who are in conflict • Move dangerous objects out of reach/view of client • Remove people/objects that upset client • Utilize people/objects that have positive effect on client • Do not violate client’s personal space • Move slowly, if necessary, and explain actions

35. Effective Communication Skills: Encouraging Response • Calm, direct instructions • Simple acknowledgements • General leads • Broad openings in questions or comments • Seek clarification • Positive use of authority: not patronising or controlling

36. Effective Communication Skills: Encouraging Response (cont.) • Keep client talking • Stress positives • Remain objective • Discuss alternatives • Convey respect and attentiveness • Be an active listener

37. Effective Communication Skills: Asking Questions • Simple and direct • Open ended • Seek reasons for client’s actions • Focus on “healthy” aspects of client • Be honest • Develop rapport

38. Communication to Avoid • Do not use analogies – be concrete • Do not challenge delusions • Do not be manipulated • Do not legalise • Do not over react to language or gestures aimed at you • Do not order, command, warn, or threaten • Do not moralise • Do not name call or ridicule

39. Threatening or inappropriate behaviour in a face to face situation Safe to pursue the conversation Not Safe to pursue the conversation Ask person to leave De-escalate* Doesn’t leave – call security Person leaves Responding to Threatening or Inappropriate Behaviour

40. Record incident and inform appropriate staff and departments Decide on follow-up – in consultation with Security if needed Refer threatener to University Counselling Service for Assessment or Referral Consider disciplinary action (Faculty/Division) Utilise OHSC, Equity and Diversity Policies. Discuss protocol for further incidents with all relevant staff and departments Responding to Threatening or Inappropriate Behaviour (cont.)

41. A Safety Plan A protocol for providing a co-ordinated and containing response when disturbing behaviour is identified as being “at risk’ to self or others and is on going. Supports risk management Harm minimisation Early intervention Duty of Care Monash community wellbeing Accepting of treatment If compliant the person can give permission for other parties to be consulted. It is prudent to have them sign a release of confidential information document. Step 1 Identify “At risk” Person At risk behaviour Compliant or non compliant • Non Accepting of treatment • If at risk person is non compliant it is important to be aware of confidentiality and privacy legislation. • Monash University reasonably believes that the use or disclosure is necessary to lessen or prevent • a serious and imminent threat to an individual’s life, health, safety or welfare; or • a serious threat to public health, public safety, or public welfare. • Privacy Officer 56011

42. A Safety Plan (cont.) Stakeholders may include some of: Faculty Staff Academic General Security University Community Services Health Service Counselling Monash International External Mental Health Providers Psychiatrists Forensic Services CAT teams Deputy University Solicitor DLU Family and Social Networks Step 2 Identify Stakeholders

43. A Safety Plan (cont.) Step 3 Develop Safety Plan Stakeholders meet to develop an informed co-ordinated approach to supportstudent and staff dealing with the situation • To Develop a Safety plan • . Consult with peers to collect information and understand the situation • . Decide on the course of action • . Call a meeting of stakeholders • Meeting of Stakeholders • . Appoint a co-ordinator and lines of reporting • . Identify triggers to behaviour • . Consider options • . Timing of intervention • . Document plan, record events, witness statements etc • . Define roles of stakeholders • . Schedule feedback to stakeholders

44. Questions