Myths, Realities, and Effective Practice in Addressing Violence in the Workplace: Myths, Realities, and Effective Practice in Addressing Violence in the Workplace Ronald Schouten, MD, JD Associate Professor of Psychiatry, Harvard Medical School Director, Law & Psychiatry Service, Massachusetts General Hospital President, KeyPeople Resources, Inc. ©2007 Ronald Schouten, MD, JD


It’s Been a Bad April: It’s Been a Bad April Apr 2, 2007 1:15 pm US/Pacific 2 Dead In University Of Washington Shooting Official: UW didn't follow policy in staffer's death By Associated Press Apr 06, 2007 - 11:43:27 pm PDTSEATTLE -- A woman staffer who died in a murder-suicide at her University of Washington office could have been moved to a different building or assigned heavier police patrols had officials followed school policies, an administrator says. Sheriff: Michigan office shooting kills 1, injures 2 POSTED: 6:52 a.m. EDT, April 10, 2007


April 16, 2007 Gunman, 32 others killed in Va. shooting : April 16, 2007 Gunman, 32 others killed in Va. shooting                                                                                                                                                       


Copy Cats and More: Copy Cats and More Bomb Threats Plague Central Florida Schools POSTED: 11:43 am EDT April 21, 2007 Gunman Kills NASA Worker and Himself UPDATED: 12:09 pm EDT April 21, 2007Gunman Published: April 21, 2007 HOUSTON, April 20 — A contract worker brandishing a revolver took control of part of a Johnson Space Center building on Friday afternoon, and killed a hostage and then himself after a standoff with the police. April 21, 2007, 9:33PM Police: Poor review set off NASA gunman


The Faces of Workplace Violence: The Faces of Workplace Violence


The Faces of Workplace Violence: The Faces of Workplace Violence Rebecca Griego


Agenda: Agenda The impact of workplace trauma What we know (and don’t know) about workplace violence, victims, and perpetrators Approaches to prevention, threat assessment, and management of high risk situations


Scope of Our Discussion: Scope of Our Discussion The workplace/school distinction Physical aggression or threats of physical harm Bullying and harassment as behaviors lying on a continuum leading up to physical aggression or threats


The Impact of Threats and Violent Acts at Work: The Impact of Threats and Violent Acts at Work


Legal/Administrative Implications: Legal/Administrative Implications OSHA General Duty Clause Sec. 5 (a)(1): civil & criminal penalties; evidence in civil claims Workers’ compensation claims If violence is work related Stress/psychiatric claims Injury based claims Negligence claims Hire Retention Supervision


Legal/Administrative Implications: Legal/Administrative Implications Disability discrimination claims, e.g. university cases Defamation, invasion of privacy HIPAA and other breach of confidentiality claims Potential liability for failing to have a disaster plan: OSHA requirements Failing to plan is planning to fail: liability for poor or absent disaster planning


The Impact of Threats and Violent Acts at Work: The Impact of Threats and Violent Acts at Work General Physical injury Psychological impact New symptoms Exacerbation of pre-existing conditions Disruption of assumed sense of safety Suspicion and loss of cohesion Decreased productivity Northwestern Life Study (1993) 79% of those attacked at work had subsequent psychological problems 40% experienced disruption of work life 28% had a physical injury or became ill 15% had no negative effect


Impact of Hoaxes or Perceived Risks: Impact of Hoaxes or Perceived Risks Acute Psychological Effects of Suspected Bioterrorism (Mason & Lyons) 13 employees who believed they had been exposed to anthrax spores Definite anxiety symptoms in 45% one week after the threat was cleared


The Knowledge Base for Threat Assessments: The Knowledge Base for Threat Assessments


Defining Workplace Violence: Defining Workplace Violence NIOSH: Workplace Violence is any physical assault, threatening behavior or verbal abuse occurring in the work setting. It includes, but is not limited to, beatings, stabbings, suicides, shootings, rapes, attempted suicides, psychological trauma, threats such as obscene phone calls, an intimidating presence, and harassment of any nature, such as being followed, sworn at or shouted at.


Defining Violence: Defining Violence Targeted violence Predatory, planned Aimed at a specific individual or institution Includes acts of terrorism, whether or not politically motivated Impulsive violence May be specific or nonspecific Victim may be unintended


Defining Threats: Defining Threats Types Express or implied Direct or contingent To physically harm: Organization Self Others


Threats: Threats Purposes: Self defense Intimidation Retaliation Manipulation/Extortion Disruption Promote ideology Personal satisfaction/entertainment


Myth vs. Reality: Myth vs. Reality #1: People “just snap.” Reality With hindsight, and some investigation, we can almost always identify a pattern of deteriorating behavior, threats, etc. leading up to the action. Perceptions that the violent behavior is a new development for the perpetrator are the result of people either not knowing the perpetrator or not being aware of what others know.


Myth vs. Reality: Myth vs. Reality #2: Violence and threats are irrational Reality Both tend to be chosen as a means to accomplish an end when no other methods appear to be available. They tend to work, at least in the short term, e.g. Disgruntled workers and their effect on management “You’d better watch it.” Terrorism They may represent rational decisions made on the basis of irrational beliefs


Myth vs. Reality: Myth vs. Reality #3: Workplace violence has been growing in frequency since the early 1990s Reality A total of 564 workplace homicides was recorded in 2005 (up from 559 in 2004). However, workplace suicides were sharply lower in 2005, dropping 14 percent to a series low of 177 fatalities. Total workplace homicides of all types have dropped approximately 50% since 1994.


#3 (cont’d): #3 (cont’d)


Myth vs. Reality: Myth vs. Reality #4: Current and former co-workers pose the greatest risk of workplace violence Reality Since data have been gathered, the majority of workplace homicides have been committed by outsiders engaged in attempted robbery or other crime. (Type I) Current and former co-workers (Type III) have consistently been responsible for 5-13%


The Four Types of Workplace Violence: The Four Types of Workplace Violence % of homicides Type I: Criminal Intent (~75%) Type II: Customer/Client (~5%) Type III: Worker on worker (~12%) Type IV: Personal relationship (~8%)


Non-fatal Assaults: Non-fatal Assaults The OSHA problem: under-reporting 1993-1999: (BJS; Mark Lies, Esq., Seyfarth Shaw 2005) 94% of workplace violence incidents involved simple or aggravated assaults 52% of workplace violence victims failed to report the crime to the police Women less likely to report than men 1999: 27% of employees who were physically assaulted in the workplace failed to report to anyone


Myth vs. Reality: Myth vs. Reality #5: Research studies have established profiles of perpetrators of violence at work and school. Reality There have been no scientific studies of workplace homicide perpetrators US Secret Service Studies of school shooters and presidential assassins have shown that there is no definitive profile For any low incidence phenomenon, like workplace violence or suicide, even very sensitive tests result in an unacceptably high rate of false positives, i.e. over-prediction.


The Mad Bomber and the Origins of Profiling: The Mad Bomber and the Origins of Profiling


The Olympic Park Bombing: The Olympic Park Bombing


#5 (cont’d): #5 (cont’d) Profiles have the problem of both false positives (over predicting who may be violent) and false negatives (missing those who do not fit the profile but are at risk. Empirically-based research has identified risk factors for non-fatal violence.


Myth vs. Reality: Myth vs. Reality #6: There are no profiles, so we can’t assess risk. Reality Those who do act often share common characteristics, although the same characteristics may be present in a significant portion of the population Utility of investigating risk factors Heightened awareness Inform management strategy during an incident Determine level of risk, rather than predicting Risk factors have been identified


The Violence Formula: The Violence Formula Violence is the product of : Individual variables (personality traits and illness) Environmental variables (whether the environment promotes or dissuades violence) Situational variables (acute and chronic stress): FINAL Financial Intoxication Narcissistic injury Acute or chronic illness Losses


Aggressive and Violent Employees: Who Are These People?: Aggressive and Violent Employees: Who Are These People? One description (Jockin,et al 2001) Sample of 489 employed men (32-36) asked about involvement in workplace aggression and conflict Involvement correlated with: Past antisocial behavior Alcohol abuse Tendency to stress reactions Aggressiveness Low self control Factors modified by perceived victimization


Validated Individual Risk Factors for Perpetrators Include: Validated Individual Risk Factors for Perpetrators Include Unsatisfied by treatment from supervisor (Baron et al., 1999; Cole et al., 1997) Younger age (Baron et al., 1999; Warren et al., 1999) Male sex (Baron et al., 1999; Warren et al., 1999) Union membership (Baron et al., 1999) Being laid off (Catalano et al., 1993) Trait anger (Douglas & Martinko, 2001) Thinks revenge is justified (Douglas & Martinko, 2001) Tends to blame other people for things (Douglas & Martinko, 2001) Previous exposure to aggressive cultures (Douglas & Martinko, 2001) History of anti-social behavior (Jockin et al., 2001) Alcohol abuse (Jockin et at., 2001) History of criminal behavior (Warren et al., 1999)


Validated Risk Factors for Organizations: Validated Risk Factors for Organizations Pay cuts or freezes (Baron & Neuman , 1996) Use of part-time employees (Baron & Neuman , 1996) Changes in management (Baron & Neuman , 1996) Increased diversity in workforce (Baron & Neuman , 1996) Computer monitoring of employee-performance (Baron & Neuman, 1996) Reengineering (Baron & Neuman, 1996) Budget cuts (Baron & Neuman, 1996) Deteriorating physical workplace environment (Baron & Neuman, 1996) Workplace located in city (Baron et al., 1999) Employment in the industry is unexpectedly low (Catalano et al., 1993) Organization faces low work-group harmony (Cole et al., 1997) Conducting terminations with more than one employer present (Karl & Hancock, 1999) Conducting terminations on a Monday or Tuesday (Karl & Hancock, 1999)


Myth vs. Reality: Myth vs. Reality #7: Mental illness is the most significant risk factor for violence Reality Absent active psychotic symptoms, the risk of violence for mentally ill individuals (excluding substance abuse) is no higher than for demographically similar members of the same community who have never been treated


#7 (cont’d): #7 (cont’d) Individuals most at risk Psychotic disorders History of Oppositional Defiant Disorder as children, Antisocial Personality Disorder as adults


#7 (cont’d): #7 (cont’d) Psychotic symptoms most related to violence: threat/control override symptoms Symptoms which involve overriding of internal self-controls by external factors Symptoms which imply a specific threat of harm from others: How often have you felt that there were people who wished to do you harm?


#7 (cont’d) Substance Abuse as a Risk Factor: #7 (cont’d) Substance Abuse as a Risk Factor Self report of violence in previous year: DX % None 2 OCD 11 Bipolar/mania 11 Panic disorder 12 Major depression 12 Schizophrenia 13 Cannabis use/dependence 19 Alcohol use/dependence 25 Other use/dependence 35


The Role of Anger: The Role of Anger As part of a disorder Anger attacks and depression Anger and psychosis Anger and personality disorders As a personality trait


Myth vs. Reality: Myth vs. Reality #8: The main issue in threat assessment is on whether an actual threat has been made Reality Those who act often never threaten the subject Those who threaten often do not act Those who act may issue threats to third parties Important to distinguish targeted violence vs. impulsive violence


Myth vs. Reality: Myth vs. Reality #9: “It will never happen to us.” vs. “It will definitely happen to us.” Realities of risk perception Probability neglect: When strong emotions are involved, people focus on the severity of the outcome, rather than the probability that the outcome will occur We tend to overestimate the likelihood of low probability events, and underestimate the likelihood of higher probability events Risk appreciation factors Availability of an example Identification with the victims Nearness to the event Nature of the trauma Perception that the risk can be reduced


Myth vs. Reality: Myth vs. Reality #10: These situations are best handled by a single person. Reality These are complicated problems; no two are exactly alike No one field has the requisite knowledge and insight to sort these all out Information, the decision making process, and organization are key Team approach provides the highest yield


Effective Strategies in Assessing and Managing Threats and Violence: Effective Strategies in Assessing and Managing Threats and Violence


Risk Assessment and Management: Risk Assessment and Management Many moving parts to the problem Focus on behavior rather than diagnosis It’s a clinical management problem that requires Obtaining as accurate a history as possible Assessment of risk factors An understanding of how to modify the risk factors to decrease the risk of harm to individuals (including the subject of concern) and the organization


Effective Strategies: Effective Strategies Workplace violence and crisis management policies in every organization Threat management teams Outside consultation available as needed Incident Command System model Liaison with local law enforcement Published resources ASIS International (2005): Workplace Violence Prevention and Response Guideline ATAP (2005): Violence Risk Assessment Guideline


Early Interventions to Head Off Problems: Early Interventions to Head Off Problems Detecting conflict Conflict resolution strategies Stress management Does this employee need help? Talk to them Clinical referrals, e.g. EAP, company physician Expectations for the clinical referral Fitness for duty evaluations


Counseling the Problem Employee: Counseling the Problem Employee Be aware of, but don’t anticipate, the worst. Empathy Respect: humiliation as a risk factor Limit setting Honesty Generosity Flexibility Privacy


Response to an Ongoing Event: Response to an Ongoing Event Leadership is key Visible Communications Information: specific, actionable, accurate Priorities: safety, health, food/water, family contact Managing the perceived threat Safety first Understanding the motivation of the threat Perception of victimization is key


The Aftermath: Responding to Victims: The Aftermath: Responding to Victims Threat or other perceived danger Empathy Setting limits on demands Education vis a vis risk perception Honesty Generosity Flexibility Privacy


The Aftermath: Responding to Victims: The Aftermath: Responding to Victims Actual violent event Physical safety comes first Communication Employees in touch with families Media Customers and investors Honesty What is known What was done Further follow up Arranging for follow-up services Internal External


Post-Event Response: Post-Event Response What do people need to avoid long-term psychological consequences? The prevalence of resilience Efficacy of community support The CISD/M controversy


Conclusion: Conclusion Greatest risk of violence is from outside The dangers of profiles Risk assessment as a process Identification and management requires: Policies Enforcement Awareness of risk factors Flexibility Willingness to respond Ability to respond Cooperation Recognition that it’s rarely easy Team approach ©2007 Ronald Schouten, MD, JD