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Institutions Violent – What Should Do and Factors


Human service professionals often encounter acts of violence in their daily work. James, Gilliand, and James (2008) have noted that violent behaviors in institutions are mainly precipitated by such elements as gender, mental illness, drug and alcohol abuse, gangs, as well as deinstitutionalization. Increased cases of violence have been linked to a rise in the number of people abusing drugs. Gender stereotypes can also play a role in precipitating violence as some of the social and cultural stereotypes associate males with increased cases of violence, in comparison with females. On the other hand, the elderly are identified as being more vulnerable to violent attacks compared with the youth. The following essay shall examine the precipitating factors of violence as well as the institutional and staff culpability, legal liability, and the nine stages of intervention as discussed by Piercy (1984).

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Precipitating Factors

The American Psychological Association published a report in 2000 which critically showed the urgent need for improved clinical education and training in the management of behavioral emergencies in clinical practice (American Psychological Association, 2000). Newly recruited clinicians are at a higher risk of falling victim to cases of violence owing to their inexperience, compared with older therapists who are more experienced. This is because they are not alert and may not identify possible cases immediately.

Some of the psychiatric clinics assign severely sick patients to clinicians who are still undergoing training thereby contributing to the increased susceptibility for attacks by patients. Patients with specific disorders are more prone to attacking their therapists in comparison with the rest of the patients. In addition, patients diagnosed with Schizophrenia and Axis II disorders have been known to be violent towards their therapists. The research conducted before the publishing of the report indicates that violent patients tend to be young and predominantly men. Furthermore, these patients are more aggressive than the female and old male patients.

Therapists are exposed to violent behavior by patients because they do not want to be accused of malpractice. Also, when therapists are attacked by patients, they do not take any measures to defend themselves. This leaves them vulnerable to random attacks by aggressive patients because they know that nothing will be done in self-defense (American Psychological Association, 2000).

Institutional Culpability

The report by the American Psychological Association advises that medical practitioners need to be formally educated and trained to deal with patients’ violent behavior. This can be done by including behavioral emergencies in their training program. Medical institutions have a role to play in ensuring continuous improvement by organizing post-doctoral workshops and courses to discuss new trends in their field as well as sharing knowledge on the treatment and handling of patients with mental disorders. Psychology graduates and professional programs need to teach skills necessary for handling behavioral emergencies (American Psychological Association, 2000).

Staff Culpability

The therapists and clinicians are advised to learn and observe life-threatening behaviors and know how to handle them professionally. Psychologists are required to perform their duties in a professional manner and must possess sufficient education and training in handling behavioral emergencies. Psychologists are not meant to practice outside their area of competence and if at all they should handle cases that are outside their area, they will require additional skills and competencies to handle them. New staffs with no experience in handling trauma undergo emotional and psychological difficulty and as such, they need to work under supervision in hospitals where such cases exist (American Psychological Association, 2000).

Legal procedures should be fair to clinicians who have been exposed to violent behavior from patients by allowing them to give their medical opinion and prevent them from being accused falsely without considering their position as caregivers. The legal aspect ensures that the psychiatrists adhere to specified standards of care while managing behavioral emergencies. This means that they can be held liable for malpractice and negligence and legal action can be taken where necessary to punish those who do not adhere to the regulations (American Psychological Association, 2000). The legal discovery process applies to clinicians who choose to divulge patient information to external people as this is considered non ethical. There are cases where violent patients hold institutions and their employees liable for failure of duty of care owed to them. In this case, the patients accuse institutions and their staffs of lack of proper diagnosis and treatment (James, Gilliland & James 2008, pp. 545).

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Stages of intervention

There are nine stages of intervention as discussed by Piercy (1984). These are education, avoidance of conflict, appeasement, deflection, time-out, show of force, seclusion, restraints and sedation. In all these stages, personal dignity and responsibility are important. Also, it is important to uphold personal dignity and respect during treatment. It also worth noting that talking to the violent patient is a dominant feature of the first five stages of the intervention as it helps to alter the patient’s violent status and establish a sense of control (James, Gilliland & James 2008, p. 555).


American Psychological Association (2000). Report on education and training in behavioural emergencies. Web.

James, K., Gilliland, B. & James, L. (2008). Crisis Intervention (7th Edition). Stamford, Mass.: Cengage Learning.

Piercy, D. (1984). Violence: The dry and alcohol patient. In J. T. Turner (Ed.), Violence in the medical care setting: A survival guide. Rockville, MD: Aspen Systems.

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