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Why safety needs to be 'built in'

October 31, 2011
by Declan Wynne, MA, LMHC, Kevin St. Jacques, PhD, and Katrina Egner, MA, LMHC
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Sound Mental Health shares a culture of safety for staff, consumers, and the community

Safety and safety planning is a vitally important element in any modern clinical setting. Regardless of any academic credentials or training, behavioral health physicians, clinicians, therapists, and staff must rely on a range of professional assets to ensure safety as they do their jobs. Among the most valuable assets are the ability to negotiate, the ongoing awareness of occupational and personal safety, and the ability to assess the treatment situation and surroundings.

These abilities are essential for those who work with diverse or challenging populations.Practitioners who are well prepared, by way of established and well-trained safety practices and protocols, are best equipped to work through difficult or potentially dangerous situations while ensuring the safety of all in clinical and treatment settings.

Incident sparks a new blueprint for safety

Declan wynne, ma, lmhc
Declan Wynne, MA, LMHC
Kevin st. jacques, phd
Kevin St. Jacques, PhD
Katrina egner, ma, lmhc
Katrina Egner, MA, LMHC

At Sound Mental Health (SMH), a behavioral health provider serving Seattle and King County, Wash., a 2004 incident involving a mentally ill, developmentally disabled client and a staff member served as a catalyst to reconsider and strengthen the agency's safety policies.

Like many behavioral health organizations, SMH has grown to offer a series of specialized programs, bringing its staff and providers into contact with a range of client populations. These include not only seriously mentally ill and developmentally disabled clients, but also 3,000 forensic clients, including offenders who are mentally ill or under the influence of substances.

Most mental health agencies, historically, are not oriented toward a safety model, given that mentally ill individuals are not prone to violence. This orientation may well explain the remarkable lack of evidence-based safety protocols nationwide. However, agencies working with any unknown or potentially hostile populations should mandate a formalized program and training infrastructure complete with a unique set of safety protocols, policies and procedures for all employees.

Since its unfortunate incident in 2004, SMH's safety policies, protocols and procedures have reduced adverse client incidents and ensured greater safety for all.

Who “owns” your policies and procedures?

So, who's going to take responsibility, draw up the blueprint and own the implementation of a safety protocol in your organization? Who will filter through best practices and past incident responses and adapt them to your organization? The first step is to identify a team to spearhead the development and refinement of your safety program.

SMH believed that our Crisis Services department, which was well-heeled in handling adversity, was ideal. This department, in our view, possessed expertise assessing dangerous situations and brought extensive experience in skilled interventions. And, since then, SMH has built an agency-wide safety team with representatives from all outpatient sites to represent diverse safety concerns and needs.

Committed team learning and staff training

The charge of our safety team is to continually obtain the latest practices, factor in real-world incident analyses, and create training programs and updates appropriate for the organization and all of our service settings. Each year, the team presents comprehensive-and mandatory-all-day training for all staff that applies and exercises this new knowledge.

Of course, training may also be episodic, based on the occurrence of adverse events. Should these occur, safety team members have organized debriefings where they collaborate with community partners, state corrections programs, safety experts, and police crisis intervention specialists. Lessons learned by safety practitioners factor into new safety training for all.

At SMH, for example, we attend trainings from safety experts including nationally-recognized crisis intervention experts like Ellis Amdur and the Seattle Police Crisis Intervention Team (CIT) as part of the revision process for training materials. We also leverage safety training curricula created by the state's Department of Social and Health Services and the University of Washington that are available to all state community mental health agencies.

Among the policies to be considered and trained as part of any safety program are these basics:

  • No weapons

  • Travel in pairs

  • Ensure access to a company phone

  • Consult regularly with supervisors, police, and community partners

  • Follow a “when in doubt, back out” policy

It takes a community of partners

Partnerships are the lifeblood of safety programs, not only because they provide access to best practices and experience, but also because they help keep any safety team appraised of the latest community safety concerns. For this reason SMH safety team members work closely with local law enforcement and the State of Washington Department of Corrections Community Corrections Office.