Mental health articles

OF mental health care and mentally ill

How to deal with aggressive or violent

Questions to ask the family or friends

• What happened? One person’s description of violence may be quite different from another’s.Find out exactly what happened.

• How did it start? Has the person been irritable for several days, or was this a sudden outburst?Sudden aggression is often caused by a specific trigger, such as an argument about drinking.Aggressive behaviour without any warning is rare, but may happen in people with a severemental disorder.

• Has this ever happened before? If so, then the chances are that further violence may occur.

• Has the person suffered from a mental illness in the past? Is he on any medication? This is ofobvious importance since it may provide important clues for treatment.

• Whom does he trust? This person could be an important ally in helping him calm down.• Does he have a drug or alcohol problem?

Questions to ask the aggressive person

• What happened? You may get a different point of view from the aggressive person than fromfriends and family. In particular, ask whether there were any reasons for her becoming violent.

• Do you still feel angry? If yes, ask her if she would prefer to spend some time alone before youask any more questions.

• Have you been feeling under stress? Have you been feeling as if people around you were behavingstrangely? That they were talking about you? Or doing things that could hurt you? Thesequestions help assess whether she has a psychosis.

• Have you heard people talking about you? Can you hear voices even when there is no onearound? Hallucinations are an important sign of psychoses.

• Have you been drinking alcohol (or, if appropriate, taking drugs) recently? How much? Whenwas your last drink?

Interview suggestions

• Be aware of the signs of impending violence. These include:

• talking louder or becoming abusive or threatening;

• fists opening and closing;

• breathing rapidly;

• fidgeting;

• tapping or punching or slapping tables, walls or the floor.• Listen for signs that the person’s speech is not making anysense or is too fast – this is a sign of intoxication or psychosis.

• Be aware of the smell of alcohol or of skin marks of injections(a sign of drug misuse);

• Look for signs that the person is losing balance or has slurred speech, which would suggestintoxication with drugs or alcohol.

• Be sensitive to your own feelings; if you feel scared, then you should stop the interview.• Make sure that both the interviewee and you have access to the door of the clinic room.

• Speak in a clear, calm tone; do not shout in an attempt to calm the person.

• Never threaten the person. This can only worsen the situation.

• Ensure that another health worker is available during the interview. If this is not possible, get atrusted relative or friend to sit with you.

• If the person has a weapon, reassure him that you are a health worker and that there is no needfor a weapon in the clinic. If he refuses to hand over the weapon, leave the room and call the appropriate security staff to disarm him.

• If the person becomes violent, first try to tell him to calm down by firm reassurance. If this is notpossible, you will need to restrain him.


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