Psyched Out

Kim commented on the post Bounty Hunting asking if I run into scary or violent situations as a psychiatric social worker. I encounter scary situations from fairly often, but violent situations much less frequently. The neighborhoods I go to are often violent ones, but by avoiding after school hours, not making eye contact and so on I manage. If I'm really uncomfortable with where I'm going or who I'm seeing, I find someone else to go with me, and I always carry my phone. The social workers who end up dead usually work for Child Protective Services. After all, the adults they encounter are usually violent against children in the first place. And people get very angry and very dangerous over custody issues.

I'd like to emphasize that although people with paranoia can become violent, they are more often too terrified of other people even to defend themselves properly from the violence they encounter (on the streets when homeless, for example). Usually if I go out "bounty hunting" and a person is paranoid they hide and don't answer the door. And those people who are having violent or homicidal inclinations are typically not directing them at social workers. Usually their feelings are focused on individuals who play a bigger role in their lives. People with violent ideation are generally hospitalized rapidly before things get out of hand. Even patients who are potentially violent most often have disorganized thinking too severe to plan and carry out crimes. Not every violent person with a mental illness commits violence due to their illness, but that is another post for another time.

The time I encounter violent tendencies is when I am assessing someone for hospitalization, and we do that in pairs if a person has any assaultive history. I've encountered a fist raised at me, a person advancing on me looking dangerous and talked people down from homicide while other staff kept watch on me. But typically I get what I need for a petition (for involuntary hospitalization) before things get actually risky. The law has protections for patients in case we make a mistake in assessing someone's risk level. Every petitioned patient has a hearing where staff have to prove to a judge that the person really needs to be in a locked psychiatric unit.

When in treatment, mentally ill people are not more violent than the general population. Of course you can't force medication into a patient's body against their will unless they are court ordered for hospitalization. My agency can only put people back in the hospital, we ourselves can't compel treatment. Outpatient people can always refuse.

The only time I was actually attacked involved an autistic adult, not a mentally ill person. That was bad. He bit through the nerves of one finger but didn't manage to sever it, and I got bites over my scalp, hands and chest. My hand with the bitten finger grew to about double its size with infection and I had to have surgery to save the hand. Human bites are much worse than animal bites, all the nurses and doctors assured me. I was something of a hospital superstar. Random staff would encounter me and say, "So you're the one with the HUMAN BITES, huh? How did that happen?" It happened while with another staff I was trying to cushion his head from banging against the wall, and being autistic once he started biting he couldn't stop. The other staff person locked me in the room with him while she called 911, which didn't help. Fifteen years with mentally ill people, no problem. One month with an autistic adult - BAM! I'm sure most autistic adults are safe as well, this is just my experience.