AAWVP

Healthcare’s failure to address link between mental illness and violence putting lives in jeopardy

Posted on July 29, 2014 9:50 am by Caroline Ramsey-Hamilton Comment

DATELINE: JULY 28, 2014

Richard Plotts, the man who allegedly murdered a 53-year old caseworker at a suburban Philadelphia hospital last week by shooting her in the face, was formally charged with murder on Saturday following surgery to remove bullets in his torso.

According to Delaware County District Attorney Jack Whelan, police in Upper Darby, Pa., where Plotts lived, were aware of at least three mental health commitments, including once after he cut his wrists and once when he threatened suicide — but said such stays can last just one to three days. Whelan also noted in his press conference that Plotts had also spent time in a mental health facility.

Every week brings a new story in the media about murder-suicides, patients killing healthcare workers, random shootings and assaults. We can read the new polls like the article on U.S. shootings in healthcare, as well as the recent healthcare crime study by the International Association of Healthcare Security and Safety (IAHSS) that routinely reports that violence in healthcare is soaring.

Not only in healthcare, but throughout the U.S., these random active shooter trends are increasing. To see how much of this violence is related to severe mental health problems, we only have to look as far as these high profile incidents:

June 14, 2012 – Buffalo, N.Y., trauma surgeon shooting
July 20, 2012 – Aurora, Colo., movie theater shooting
Sept. 16, 2013 – Washington Navy Yard shooting
Dec. 17, 2013 – Reno, Nev. urology clinic shooting
Jan. 22, 2014 – LAX active shooter incident
April 2, 2014 – Fort Hood (2nd) active shooter incident

None of these incidents were related to poor performance review, losing a job, and only one of these could be called “domestic violence,” but what they all have in common is that the perpetrators were all severely mentally ill.

Guns scare me. Guns kill people by accident and on purpose. I never let my children play with guns. However, as I analyze the elements of these shootings and dozens more, my bias is changing. I think it’s less about guns and more about mental illness.

Healthcare and hospitals would be the one industry where you would think that people would be concerned about the state of mental health of their patients and staff. Instead, it seems like mental health problems are walled off by society, treated ineffectively, and violent tendencies (which sometimes make their way onto patients’ Facebook pages) are largely ignored and unreported by the clinicians treating them.

So it’s left to the security and law enforcement community to deal with these individuals who are paranoid, depressed, angry, frustrated, disappointed, hurt, confused, and, ultimately, violent.

Now that mental health has been re-classified as another medical problem, the money is flowing to the treatment centers and it’s covered by Medicare. But progress doesn’t seem to be either easy or effective.

Dr. Graham C.L. Davey, Ph.D. writing in Psychology Today in January said: “Many of those health professionals (GPs and family physicians) at the first point of contact with people suffering mental health problems are poorly trained to identify psychological problems in their patients, and have little time available to devote to dealing with these types of problems. This increasingly makes medication prescription an attractive option for doctors whose time-per-patient is limited—an outcome which will have all the potential negative effects of medicalizing the problem into a “disease.”

And that’s exactly what we see, patients who don’t take their meds because of the negative side effects and so they become isolated and increasingly violent. The side effects are clearly pointed out in TV commercials, that you’ve probably watched.

For example, one medicine has side effects that include sexual side effects, convulsions, brain shrinkage, stroke, death, suicide, violent thoughts, psychosis and delusional thinking.

The increase in hospitals adding seclusion rooms, expanding the number of beds for psych patients, and the time spent by both law enforcement and security professionals in dealing with these troubled individuals, may account for one-quarter to one-third of an organization’s security budget.

Many of the security risk assessments we do are focused on handling mobile mental patients, including the baby boomers suffering from Alzheimer’s and dementia.

As violent incidents continue to increases in our society, our workplaces, and in our hospitals, we need to spend more time looking for, and demanding treatments that work and that are sustainable by the patients so they can lead happier lives and we can protect the rest of society, and our healthcare facilities, from their potentially violent behavior.

http://www.securityinfowatch.com/blog/11598089/healthcares-failure-to-address-link-between-mental-illness-and-violence-putting-lives-in-jeopardy

Author: Caroline Ramsey Hamilton

Since 1988, Caroline Ramsey-Hamilton has been a Thought Leader in All Aspects of Active Shooter and Security Risk Assessment in both Public and Private companies and organizations. Specializing in Hospital and Healthcare Security. Hamilton is Certified in Homeland Security (CHS-III), Anti-Terrorism (ATAB) and Security Risk Assessment. As President of Risk & Security (www.riskandsecurityllc.com) she works with many hospital clients, and develops affordable risk-based apps for improving security risk assessments, and publishes the RISKAlert security awareness program. She lives in south Florida with two beagles, a rescued kitty and (on weekends), 4-year old twins.

Reprinted with permission from www.SecurityInfoWatch.com

What’s Your Active Shooter Risk? How to Assess the Threat!

Posted on October 15, 2013 4:54 pm by Caroline Ramsey-Hamilton Comment

Just the idea of an Active Shooter in your organization, whether you’re a military base, like Fort Hood, and the Washington Navy Yard, or a school like Sandy Hook, a beauty shop, a cracker factory in Philadelphia, a retail mall, a movie theatre, a grocery store parking lot, or a hundred other places, is a terrifying thought.

I lived about 3 miles from one of the shooting sites, a gas station, used by the Beltway Snipers back in October, 2002. They killed ten people, totally at random, and critically injured three others. Both of the snipers were sentenced, and John Muhammad was killed by lethal injection in 2009.

If you lived in the DC area, do you remember how scary it was just to pump gas into your car, people were huddled against the side of their cars in the gas stations, and hidden by their shopping carts at the local Home Depots.

The fear of the Active Shooter comes from the seeming randomness of the action, which means there’s no way to prevent it, unless you give up, stay home, and hide under the bed all day.

But there are things you can do. Instead of thinking of an Active Shooter incident as a totally unique situation, it’s really a form a Workplace Violence, Gas Station Violence, Parking Lot Violence and other related forms of random violence. In fact, the Department of Homeland Security has identified quite a few steps you can take to keep yourself safer if you are in the vicinity of an active shooter (http://www.dhs.gov/active-shooter-preparedness).

Most of the shooters are mentally ill. Normal individuals do not enjoy planning and killing strangers, and it is usually a last ditch effort, with the suicide of the shooter as the grand finale. Their actions can sometimes be identified early, and the police can be alerted, or the Human Resources group at work, or even the local Sheriff can intervene before it gets to the actual shooting.

Signs that someone is having trouble negotiating their life, especially if that someone is a gun fanatic, with their living room full of AK-47 assault weapons and hollow point bullets, is not hard to spot, because these individuals often leave lots of warning signs, like:

Irrational Posts on Facebook or inappropriate tweets.
Threats made against friends and family.
A dropoff in personal hygiene, as the person gets more obsessed.
Problems negotiating their personal life.
Demonstrating signs of isolation and groundless paranoia

Organizations can protect themselves from an potential active shooter through a combination of specific controls that include elements like access control, continuous monitoring of cameras, employee awareness and training programs, clear cut evaluation routes, regular active shooter drills, and hardening of facilities, to name a few.

One of the best preventive measures is to conduct an Active Shooter Risk Assessment, which is similar to other security analyses, except that it is focused on a particular set of threats related to an Active Shooter Incident. As part of my annual Threat Trend Reports, I’ll be releasing a new set of threat data about the Active Shooter, to help organizations calculate their risk of
having such an incident. For example, did you know that the number of active shooter incidents has jumped from 1 in 2002
to 21 incidents in 2010?

Locations have changed, too, and we found that

About 25% of active shooter incidents occur in schools,
About 25% in retail locations, and
About 37% in workplaces.

In future blogs, we’ll be looking at each element of the active shooter incident, and providing more information to keep
your organization safe.

Has it Been Only Two Weeks since the Navy Yard Shootings?

Posted on October 2, 2013 4:07 pm by Caroline Ramsey-Hamilton Comment

When i wrote my blog about the Shootings at the Washington Navy Yard on September 16th, I got some nasty notes about “Why did you have to write about this so soon after it happened?”

Well – I guess the fact that after about 15 days, no one can even remember the incident (8 people shot to death); the name of the shooter (Aaron Alexis), or much of the details. It seems that people have decided that it was a mentally distributed person, so couldn’t have been prevented. This is completely wrong.

One of the issues that security directors have is how to make their organization aware of the active shooter threat without terrifying them. How do you get a large group of people out of the “It can’t happen here” mindset? One of the main ways to bring an issue back home is by using the incident as a security awareness notice.

Write a “Lessons Learned” email and send it to everyone in the organization. Follow it up with a purse and wallet card with reminders on what to do when faced with an Active Shooter situation.

Keep everyone informed on what happens after the incident – how the injured are doing, and more importantly, what changes the organization has made to ensure that it won’t happen again.

Try doing a simple threat-risk assessment to illustrate to management what the chances of having an active shooter incident actually are, based on the industry, the region, and the number of problems/complaints that employees have expressed in the past.

Don’t let anyone forget that this can happen to any organization, no matter how well funded, or how secure they think they are. Remember, if it could happen in a DOD military facility – it could happen to YOU!

Navy Yard Shooting Highlights Effect of Cuts to Navy Security

Posted on September 24, 2013 12:26 pm by Caroline Ramsey-Hamilton Comment

Security professionals around the entire were shocked and dismayed when they turned on the news and saw the historic Washington Navy Yard locked down, surrounded by emergency vehicles, and looking for an active shooter.

All the shock, the outrage, the Defense Department reaction, the involvement of the overlapping law enforcement jurisdictions, has apparently been already forgotten by the public, moved to the virtual ‘old story’ pile by the latest news of a mall shooting in Kenya, meeting at the UN, and the politics as usual in Washington DC.

If you graph it online, you can see the dramatic spike and then the dramatic drop-off in interest by the general public. This highlights what the security community has to deal with, in the context of a 24 hour news cycle.

My perspective on the event was personal because one of my very best friends was in Building 197 that day, a former navy commander, now a contractor, who went to work at 5 am that morning, and finally returned home at 9 pm that night. Unlike many shootings, the PCs, smartphones were all up and operational during the event, so people were instantly able to communicate with friends and relatives as the event unfolded.

Rumors ran rampant that it was terrorism related, that there were three shooters, then that rumor switched to two shooters and eventually to only one shooter, Alexis Aaron, a mentally disturbed young man who had previous events of gun violence and yet had a top secret security clearance at the time of the shooting.

If we took a poll three weeks ago and asked people which facility would they judge to be the safest, the results
would probably look something like this:

1. Military Base in the U.S.
2. Hospital
3. Regional Mall
4. Police Station

Unfortunately – this is more like a list of the places where a shooting is more likely to take place. As all the work in workplace violence statistics shows, a domestic Military Base has been the site of two mass shootings in only the last 4 years. This includes the twelve killed and eight wounded at the Washington Navy Yard, as well as the thirteen killed and twenty injured at the Fort Hood shooting in late 2009. That’s an average of 6 killed each year, and 8 injured, and doesn’t take into account any random shootings, training-related injuries, only the mass shootings.

Hospitals have increased in violent incidents every year for the last ten years, and we just witnessed a mass shooting at a Kenyan Mall.

However, the hospital and the mall are both completely OPEN, they want people to come in, they don’t control access at all.
This is what is so surprising about the Navy Yard shootings, the lack of security, lack of enough armed guards, lack of current background checks, lack of metal detectors, lack of retina scanners, and every other usual form of security control.

Speculation is that the key controls were missing because of budget cuts, which means that the Navy made the decision to reduce security controls, instead of cutting other, less critical programs. The incident makes a strong case for examining the potential Return on Investment for security controls!

Even if the shooter’s background check was “current”, it certainly had not been updated based on his own recent events, and brushes with the police, and, of course, the anger and mental health problems appears again, and is shrugged off as too tough to manage and track.

However, it is a wake up call for the U.S. Navy, the Department of Defense, the U.S. Capital Police, and a variety of other organizations who “Secure” the Washington DC Capitol zone, and it leads to more questions than answers.

Already, the questions are starting about what controls SHOULD be in place for all military bases, and, naturally, re-examining the background check process and how it could be updated and improved.

Let’s not forget this time.

How long does it take for OSHA to develop standards – like for Workplace Violence?

Posted on May 1, 2012 6:44 pm by Caroline Ramsey-Hamilton Comment

Why OSHA standards take so long to develop

The Government Accountability office reports to Congress on items of interest to Congress and their constituents. One area that was recently examined was how long it takes OSHA to update standards, or develop new standards. Here’s a look at the results:

By: David LaHoda April 30th, 2012

A report by the U.S. Government Accountability Office (GAO) on why OSHA standards take, on average, more than seven years to complete found that “increased procedural requirements, shifting priorities, and a rigorous standard of judicial review” contributed to the lengthy time frame.

In responding the GAO report, Randy Rabinowitz, OMB Watch’s director of regulatory policy said: “In the years since its creation, OSHA’s charge to protect workers from harm has been undermined by Kafkaesque demands for additional reviews of existing rules mandated by new statutes and executive orders,” according to The Hill. While OSHA’s internal inability to remain focused on priorities and regulatory follow-through was the counter argument presented by the U.S. Chamber of Commerce.

“While some of the changes, such as improving coordination with other agencies to leverage expertise, are within OSHA’s authority, others call for significant procedural changes that would require amending existing laws,” according tot he GAO report.

The GAO report recommended that that OSHA and NIOSH improve collaboration on researching occupational hazards. In that way OSHA could better “leverage NIOSH expertise in determining the needs for new standards and developing them.”

To access the entire 55-page report, go to: http://www.gao.gov/products/GAO-12-330

April is Workplace Violence Awareness Month

Posted on April 10, 2012 6:11 pm by Caroline Ramsey-Hamilton Comment

The American Association of Workplace Violence Prevention (www.aawvp.org) has designated April 2012 as official Workplace Violence Awareness Month!

You can celebrate in your office by suggesting ways to reduce workplace violence in your own environment. At AAWVP, they stress that workplace violence also happens to you, not just at work, but at the late-night grocery store or convenience store, in the hospital where you’re visiting your father, and even in your own home.

As part of the awareness raising event, the Association has invited me to participate in a special webinars about workplace violence at 2:00 pm Eastern Time, on April 18th.

You can join us by registering at http://tinyurl.com/85e33h8