1 Myths, Realities, and Effective Practice in Addressing Violence in the Workplace Ronald Schouten, MD, JD Associate Professor of Psychiatry, Harvard.

1

Myths, Realities, and Effective Practice in Addressing Violence in

the Workplace

Ronald Schouten, MD, JDAssociate Professor of Psychiatry, Harvard Medical School

Director, Law & Psychiatry Service, Massachusetts General HospitalPresident, KeyPeople Resources, Inc.

©2007 Ronald Schouten, MD, JD

2

It’s Been a Bad April

• Apr 2, 2007 1:15 pm US/Pacific2 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

3

April 16, 2007

Gunman, 32 others killed in Va. shooting

4

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, 2007HOUSTON, 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, 9:33PMPolice: Poor review set off NASA gunman

5

The Faces of Workplace Violence

6

The Faces of Workplace Violence

Rebecca Griego

7

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

8

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

9

The Impact of Threats and Violent Acts at Work

10

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

11

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

12

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

13

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

14

The Knowledge Base for Threat Assessments

15

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.

16

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

17

Defining Threats

• Types- Express or implied- Direct or contingent

• To physically harm:- Organization- Self- Others

18

Threats

• Purposes:- Self defense

- Intimidation

- Retaliation

- Manipulation/Extortion

- Disruption

- Promote ideology

- Personal satisfaction/entertainment

19

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.

20

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

21

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.

22

#3 (cont’d)

23

24

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%

25

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%)

26

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

27

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.

28

The Mad Bomber and the Origins of Profiling

29

The Olympic Park Bombing

30

#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.

31

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

32

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

33

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

34

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)

35

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)

36

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

37

#7 (cont’d)

• Individuals most at risk– Psychotic disorders– History of Oppositional Defiant Disorder as

children, Antisocial Personality Disorder as adults

38

#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?

39

#7 (cont’d) Substance Abuse as a Risk Factor

Self report of violence in previous year:DX %None 2OCD 11Bipolar/mania 11Panic disorder 12Major depression 12Schizophrenia 13Cannabis use/dependence 19Alcohol use/dependence 25Other use/dependence 35

40

The Role of Anger

• As part of a disorder- Anger attacks and depression

- Anger and psychosis

- Anger and personality disorders

• As a personality trait

41

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

42

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

43

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

44

Effective Strategies in Assessing and Managing Threats and Violence

45

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

46

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

47

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

48

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

49

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

50

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

51

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

52

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

53

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