In my very first week working as a healthcare assistant at Ashworth Hospital, Liverpool I was thumped!
A patient, who I had met five minutes earlier, accused me of staring at him and trying to steal his thoughts. He grabbed my shirt and punched me in the chest.
It didn’t really hurt, but it was a terrifying moment.
My experienced colleagues shrugged – this was my ‘induction’.
I was shaken up by the incident, but felt that I had to ‘toughen up’ if I was to survive working with some of the most dangerous and violent mentally abnormal offenders in Europe.
One of my colleagues told me that he would carry ten cigarettes in his pocket as a way of “surviving”. He would bribe patients to comply and avoid threats or violence. That was a good idea.
That was in 1977. The thought that there could be training in violence and aggression was years away and the concept of violence and aggression training online was the stuff of science fiction.
Back then, we were only given a ‘special lead’, which in effect was danger money. So, if you were assaulted and injured, you were at least getting paid for it.
However, working with some of the country’s most violent and aggressive mentally abnormal patients in the country was much safer for employees working within secure forensic facilities like me, than colleagues who worked in A&E departments, shops or even schools.
Violence & Aggression is Still a Significant Issue
The most recently published figures produced by the Health and Safety Executive from 2019 make uncomfortable reading for employers and workers alike.
According to the Crime Survey for England and Wales (CSEW):
- An estimated 307,000 adults of working age in employment experienced violence at work, including threats and physical assault
- Approximately 688,000 incidents of violence at work, comprising of 299,000 assaults and 389,000 threats occurred
- Some 1.4% of both male and female workers were victims of violence at work once or more during the year prior to their interview
- Around 60% of workplace violence offenders were strangers to the victim,
- In the 40% of those who knew their attacker, the person was most likely to be a client, or a member of the public known through work
- Some 62% of violence at work resulted in no physical injury, while the majority of those who were injured experienced severe or minor bruising or a black eye
Verbal Assaults Can Be Just As Damaging
When one drills into some of these figures, it is often comforting to see that physical assaults occur far less frequently than threats of violence.
However, there is clear evidence that sometimes a threat of violence can be psychologically and emotionally devastating and far more seriously damaging than a physical assault.
An elderly, confused person who mistakenly believes that someone may have stolen their money and lightly slaps a carer’s face is less likely to impact as strongly as a young male customer who threatens to stab an employee in a retail setting.
The Many Impacts of Violence & Aggression
The psychological impact of such a confrontation may profoundly affect the victim’s ability to sleep, to concentrate or to process the incident and shrug it off. Furthermore, the effect of violence in the workplace is often felt by others who may have witnessed or been part of an incident.
The ripple effect of violence and aggression can have an enormous impact on the employer’s ability to retain existing or attract new staff. It can have a deleterious effect on the worker’s ability to carry out their duties effectively or efficiently. Morale in the workplace is often an overlooked casualty of violence and aggression in the workplace.
In upcoming blog posts, I will explore violence and aggression in the workplace including the importance of good risk assessments, training needs analysis examples of good training and crucial emotional support for employees post incident.
After my first experience with violence and aggression, it was to be another nineteen years before violence in the workplace was finally recognised as a reportable incident under the RIDDOR regulations 1996.
Until then, the issue of aggression and violence in the workplace was at best ignored, at worst viewed as an occupational hazard!
Examples of violence in the workplace
Generally speaking, any action or behaviour from rumours, swearing, verbal abuse, pranks, arguments, property damage, vandalism, sabotage, pushing, physical assaults, psychological abuse, rape, arson to murder are all examples of workplace violence and/or harassment. It includes:
- Threatening behaviour: Such as shaking fists, destroying property or throwing objects
- Verbal or written threats: Any expression of an intent to inflict harm
- Verbal abuse: Swearing, insults or condescending language
- Physical attacks: Hitting, shoving, pushing or kicking
Verbal abuse is a troublesome issue and often attempts are made to separate verbal or non-physical versus physical violence. In future blog posts, I will explore the vexed issue of verbal abuse, its place within the spectrum of violence and aggression and how to address verbal abuse in the workplace.
When John Brown (not his real name) was hit in the face by a drunken customer in the supermarket where he was employed as a Sales Assistant, he sustained a broken nose. His supervisor told him to go home and see his GP. She told him that she would see him the next day, when he returned to work.
John was in great pain and couldn’t breathe through his nose. He ended up going to A&E, getting X-rayed and undergoing surgery to repair a fractured eye socket.
When he didn’t show up for work the next day, his supervisor contacted his mother. His manager told her that if he wasn’t in work by the following Monday, his contract would be terminated.
When John asked his supervisor, if there should be training provided for dealing with aggression and violence, he was told that there was none. Furthermore, she informed him that he must have caused the assault because of his attitude.
The fact is violence in the workplace is a serious issue. It cannot just be ignored or defended as part of the job.
John eventually left his job.
What causes aggression and violence in the workplace?
When we think about how these incidents occur, we can’t help but wonder, what makes people so angry? The answer is anything and everything.
The fact is we know what it feels like to feel angry and we may be able to remember what last made us feel hostile towards someone.
It can be because someone who arrived after you has been served before you. Or because you were unsuccessful with a job application.
You may feel that people are talking about you in a non-complimentary way and you want to retaliate or you are feeling bullied by your manager.
The reality is, that you will also encounter employees, colleagues, customers and patients who may have these feelings that are hidden away behind a ‘happy façade’, but may suddenly explode in to aggressive or violent behaviour towards you or a colleague.
Victims and witnesses of aggression and violence will often say that the assault was completely unprovoked or just out of the blue.
However, the truth is, violence is rarely spontaneous. There are trigger factors and there are escalating points also.
The Assault Cycle
In the 1980s, psychologist Stephen Kapler and his colleague, Eugenie Wheeler, conceived the Assault Cycle. It endeavoured to explain what a violent incident looks like in terms of the how an aggressive person reaches the point of violence. The cycle breaks aggression and violence into five phases.
Many experts in this field have developed other theories to explain aggressive and violent behaviours. However, despite being almost forty years old, the Assault Cycle is easy to recognise and understand.
Below is an illustration of the cycle and you will see it is split into five phases.
In the bottom left hand corner is what we call the person’s Baseline behaviour. In other words, when they are calm, not angry, but quite relaxed.
The next stage is a Trigger Factor: Imagine you are driving your car and another motorist cuts you up. You are startled. You may honk your horn to inform them of your displeasure. This is a Trigger Factor. The other drive then responds with a wave of acknowledgement that appears to be an apology. You relax once again and your pulse rate and blood pressure return to normal.
But what if the other driver responds with an obscene gesture. Now, not only have they cut you up, they have further insulted you. This is what we call an Escalating Factor. If you follow the red line, this is analogous to your pulse and blood pressure and the rest of your body preparing for fight mode.
Suddenly, you are seeking revenge. You want to cut them up or drive dangerously close, tail gaiting them. Rational thoughts and consequences have been shelved. At the next set of traffic lights, the other driver has stopped and you seize your moment. You bounce out of your vehicle march towards the other car, pull on the driver’s door and you thump them, good and hard!
Following along on the map of the cycle, the next stage involves Possible Additional Assaults. Maybe someone watching calls you an idiot, and you turn on them!
Eventually you return to your car, you are shaking and adrenaline has you buzzing. An hour later as you are calming down, you start to think about what happened, what you may have done to the other person and what may happen to you as a consequence.
It seems ridiculous that you could behave this way. ‘It’s not like me,’ you say to yourself. This is called the depression phase of the cycle. It’s not clinical depression, but the perpetrator may go quiet and subdued as a result of their aggression and violence, before finally returning to Baseline again (bottom right).
One of the difficult aspects of the Assault Cycle, is when looking at this model, there is another element, namely, Time. What I can say with certainty, is that incidents may take minutes, hours and even fraction of seconds to travel from baseline to crisis when a person is feeling aggressive and violent.
The Assault Cycle enables us to recognise and even empathise how we too can become angry, aggressive and even violent.
Near Miss Reporting of Violence & Aggression
Along with the Assault Cycle, getting staff to report issues before actual attacks occur is a very important part of prevention. Near miss reporting systems should be a part of every prevention strategy. When working properly, they will warn you of potential future incidents, so you can be prepared in advance.
In order for this to work, all staff must be sufficiently trained in what to report and how to do it. Fortunately, near miss reporting online training and tools are available to make this easier.
A Topic That We Will Continue To Explore
In the following months, I will continue to work alongside Human Focus to produce blogs that explore the many layers of aggression and violence. I will return to the Assault Cycle as a map to understand how violence develops. But also look at how we use it as part of aggression and violence training to recognise what interventions to use at each stage. And I will discuss why getting this training in some form, such as Violence and Aggression online training, is vital.
I will talk about the micro indicators of aggression and violence that we may see but not recognise, how to rapidly risk assess potential violence and how to use effective defusion/de-escalatory skills to avoid, prevent and manage aggressive and violent people.