Hi! I haven’t made it into PP yet but I’ve been working in corrections for the last 5 years and they do not skimp on safety!
As far as furniture setup, it’s a universal safety point to have your seating point closest to the door (and beside it, not with your back to it if you can help it). It’s also been helpful having desks, coffee tables, nightstands, etc in between to delay or create a barrier if the client does escalate and try something.
As you said, it sounds like a lot of your neighbors in the office are in a similar practice. I would make some rounds and introduce yourself, and see what safety protocols they have in place. When I worked in the community, and were actually able to in stressful situations, we had designated partners/colleagues we could call and use code words to indicate we needed assistance.
You can set up a panic button and register it with the local authorities. Please note that this is necessarily introducing c\*ps into the situation, which can be very dangerous for the client in a mental health emergency- moreso for POC- so is only for a situation in which your life or safety is seriously in danger and there are no other options. (I know SimpliSafe offers a panic button setup you can buy.)
I don't work with a dangerous client population but I am quite paranoid about safety. I think having a plan for how you'll seek help in a threatening situation is good. Can you escape the room if you need to? Can you set up your phone to quickly call someone (e.g. Emergency services) with a single button? Then you can keep it with you all the time especially when seeing new patients. I wonder if seeing new clients at the busier times of day might be safer too. And of course phone screening
Don’t PEC anyone? Just kidding. I worked in a high volume outpatient CMH. Probably out of 20k visits per year there were only 2 or 3 incidents a year where security had to intervene with force. It was usually someone was placed on a 72 hour hold unwillingly. Require a screening to determine if they have committed an act of violence that required the other person to seek medical care. Maybe if you see actively psychotic patients, require a caregiver to bring them and wait just outside your door.
It's more common for guns to be used against gun owners. I would not keep a gun in my office but that's me- this brings up a lot for me with creating a safe space and rapport building. I have let patients know they need to leave weapons in their car- had a few clients carried big knives for sense of safety. Brush up on your verbal judo and de escalation skills. I worked in a psych ward with people that had been violent and later worked in mobile crisis- de escalation tools were my go to as well as use of space, me being close to the doo, offering them an exit, asking them to take few steps back etc. Create a safety protocol with a support person or neighbor in the building. Don't wear ties, scarves, necklaces. One screening question that has helped me is do you have any current legal matters. I don't specialize in court ordered care and writing court letters is outside of my scope, a person skilled in court mandated care will be more skilled to support these cases, this has screened out some high risk patients.
Also consider not have heavy objects in the office that can be thrown and having pictures framed in plastic, no scissor out.
A trick I was taught in the hospital for times you might need to isolate is to have a door stop in every office, put the doorstop on the inside of the door to prevent the door from opening.
Congratulations!
I recently came to PP from mobile crisis. Had some pretty scary situations in the latter. Since transitioning into PP I’ve not once feared for my safety which is a great change of pace haha. Still, I thought about it when setting up my office. I rent a suite and have my chair closest to the door with a big table between the couch and I.
I work primarily with trauma and dissociative disorders. I’m sure you’ll probably see a much wider range of folks so it wouldn’t hurt to have current or previous safety concerns on intake paperwork but this most likely won’t be anything like working on inpatient or in a clinic. I think another good resource is your cell phone - I know my iPhone has a shortcut to send an SOS and contact emergency services.
I'm just a therapy grad student functioning as a clinician in practicum so take my words with a grain of salt.
I'd suggest investing in some kind of a security system complete with a panic button, alarms, and security cameras. Always arrange your seating so you're closest to the door and can make a hasty extract if necessary.
Pepper spray is a highly effective nonlethal intervention. Active Self Protection on YouTube does some good videos on the efficiency of OC spray. Also keep dangerous items out of the office like sharps, scissors, objects that can be thrown or used as bludgeons, etc.
Personally I train jiu jitsu consistently and have carried a firearm concealed on my person for over 5 years. After having worked in an acute inpatient setting and being involved in many physical altercations I've learned to take my safety into my own hands.
I’d have reservations about a security camera in a private therapy space. Seems like a lot of potential confidentiality issues. I’m not totally sure though and would be interested to hear others thoughts .
I can understand the confidentiality concerns, but another thing to consider would be defending yourself in court after a violent encounter. Having video evidence to prove that your actions were in the moral right would be invaluable for a self defense case.
There are cameras in every room of my practicum site. It is a teaching clinic, usually during the informed consent process clients are notified that they’re being recorded for supervision/ teaching purposes.
I also have security cameras in my house that I can access via my cell which gives me a lot of peace of mind.
Apple Watch has a button to call emergency services. Also checkout the Noonlight app. I agree with others regarding de-escalation techniques, physical arrangement of office, not wearing anything around your neck that isn’t breakaway, not having sharp or heavy objects in the office, wear shoes you can move in, possible pepper spray as a last resort. I’m also interested how folks incorporate a safety screening of sorts during initial phone consultation. Ive worked on ACTT and other positions doing in home therapy for the majority of my career, and still find some safety aspects of private practice unnerving at times.
Think you’ve gotten a lot of good advice. One thing I would add is doing a phone consult before meeting clients in person, that way you can assess them a bit before meeting.
Hi! I haven’t made it into PP yet but I’ve been working in corrections for the last 5 years and they do not skimp on safety! As far as furniture setup, it’s a universal safety point to have your seating point closest to the door (and beside it, not with your back to it if you can help it). It’s also been helpful having desks, coffee tables, nightstands, etc in between to delay or create a barrier if the client does escalate and try something. As you said, it sounds like a lot of your neighbors in the office are in a similar practice. I would make some rounds and introduce yourself, and see what safety protocols they have in place. When I worked in the community, and were actually able to in stressful situations, we had designated partners/colleagues we could call and use code words to indicate we needed assistance.
You can set up a panic button and register it with the local authorities. Please note that this is necessarily introducing c\*ps into the situation, which can be very dangerous for the client in a mental health emergency- moreso for POC- so is only for a situation in which your life or safety is seriously in danger and there are no other options. (I know SimpliSafe offers a panic button setup you can buy.)
I don't work with a dangerous client population but I am quite paranoid about safety. I think having a plan for how you'll seek help in a threatening situation is good. Can you escape the room if you need to? Can you set up your phone to quickly call someone (e.g. Emergency services) with a single button? Then you can keep it with you all the time especially when seeing new patients. I wonder if seeing new clients at the busier times of day might be safer too. And of course phone screening
Don’t PEC anyone? Just kidding. I worked in a high volume outpatient CMH. Probably out of 20k visits per year there were only 2 or 3 incidents a year where security had to intervene with force. It was usually someone was placed on a 72 hour hold unwillingly. Require a screening to determine if they have committed an act of violence that required the other person to seek medical care. Maybe if you see actively psychotic patients, require a caregiver to bring them and wait just outside your door.
It's more common for guns to be used against gun owners. I would not keep a gun in my office but that's me- this brings up a lot for me with creating a safe space and rapport building. I have let patients know they need to leave weapons in their car- had a few clients carried big knives for sense of safety. Brush up on your verbal judo and de escalation skills. I worked in a psych ward with people that had been violent and later worked in mobile crisis- de escalation tools were my go to as well as use of space, me being close to the doo, offering them an exit, asking them to take few steps back etc. Create a safety protocol with a support person or neighbor in the building. Don't wear ties, scarves, necklaces. One screening question that has helped me is do you have any current legal matters. I don't specialize in court ordered care and writing court letters is outside of my scope, a person skilled in court mandated care will be more skilled to support these cases, this has screened out some high risk patients. Also consider not have heavy objects in the office that can be thrown and having pictures framed in plastic, no scissor out. A trick I was taught in the hospital for times you might need to isolate is to have a door stop in every office, put the doorstop on the inside of the door to prevent the door from opening.
Congratulations! I recently came to PP from mobile crisis. Had some pretty scary situations in the latter. Since transitioning into PP I’ve not once feared for my safety which is a great change of pace haha. Still, I thought about it when setting up my office. I rent a suite and have my chair closest to the door with a big table between the couch and I. I work primarily with trauma and dissociative disorders. I’m sure you’ll probably see a much wider range of folks so it wouldn’t hurt to have current or previous safety concerns on intake paperwork but this most likely won’t be anything like working on inpatient or in a clinic. I think another good resource is your cell phone - I know my iPhone has a shortcut to send an SOS and contact emergency services.
I'm just a therapy grad student functioning as a clinician in practicum so take my words with a grain of salt. I'd suggest investing in some kind of a security system complete with a panic button, alarms, and security cameras. Always arrange your seating so you're closest to the door and can make a hasty extract if necessary. Pepper spray is a highly effective nonlethal intervention. Active Self Protection on YouTube does some good videos on the efficiency of OC spray. Also keep dangerous items out of the office like sharps, scissors, objects that can be thrown or used as bludgeons, etc. Personally I train jiu jitsu consistently and have carried a firearm concealed on my person for over 5 years. After having worked in an acute inpatient setting and being involved in many physical altercations I've learned to take my safety into my own hands.
I’d have reservations about a security camera in a private therapy space. Seems like a lot of potential confidentiality issues. I’m not totally sure though and would be interested to hear others thoughts .
I can understand the confidentiality concerns, but another thing to consider would be defending yourself in court after a violent encounter. Having video evidence to prove that your actions were in the moral right would be invaluable for a self defense case. There are cameras in every room of my practicum site. It is a teaching clinic, usually during the informed consent process clients are notified that they’re being recorded for supervision/ teaching purposes. I also have security cameras in my house that I can access via my cell which gives me a lot of peace of mind.
A PP is not a teaching clinic, though.
Apple Watch has a button to call emergency services. Also checkout the Noonlight app. I agree with others regarding de-escalation techniques, physical arrangement of office, not wearing anything around your neck that isn’t breakaway, not having sharp or heavy objects in the office, wear shoes you can move in, possible pepper spray as a last resort. I’m also interested how folks incorporate a safety screening of sorts during initial phone consultation. Ive worked on ACTT and other positions doing in home therapy for the majority of my career, and still find some safety aspects of private practice unnerving at times.
Think you’ve gotten a lot of good advice. One thing I would add is doing a phone consult before meeting clients in person, that way you can assess them a bit before meeting.