The Dangerous Behaviour Masterclass 3 – Mapping Violence

Sorry for the delay. In the last Masterclass a distinction was made between Difficult and Dangerous behaviour. We have to go into this in greater depth, but at this point in the Masterclass we are simply in the process of mapping out the terrain and identifying important processes and principles. In this mapping process, one dimension can be “dangerousness” while another might be “form.” There are some others, but at this stage let’s just think one step ahead. “Form” describes the type of behaviours involved.

Typically on training courses participants express a concern about a form of behaviour or type of person(s). “What if they are drunk”, “I deal with addicts”, ” I’m really concerned about a stalker”, “Well that’s okay, but what if you’re surrounded by a gang of thugs”, “I can deal with most situations, but what if they are completely crazy?”, “What if someone is completely on a mission to do you some harm?” – and then the additional concern “What if I lose it (panic, freeze, react inappropriately, lose control of myself)?”

All these situations, and more will be dealt with in this Masterclass. Here we will briefly consider “Form” or the perceived type of behaviour with which we might be confronted. I say “perceived” because there is an extremely complex interplay between what goes on in the minds of the protagonists during a conflictual situation – again an issue to which we return.

If Difficult-Dangerous is the “depth” dimension, then what is the breadth? This is the more common arena for academics and there are many formulations to choose from. I choose to go my own way, not out of arrogance but because I arrive at the situation from a different position. I want to know what to do when confronted with all these frightening situations not just to explain them.

For this reason, I see violence as something in motion, and therefore something must be pushing it forward. What could be these “forces?” None of us would worry if they were were static – I could be supremely confident if I knew the person in front of me wouldn’t hit me. The next question, obviously, is then what pushes the behaviour into violence. I have thought about this – motives, drivers, incentives, urges, impulses – actually, in most cases we will never know.

None-the-less, in-practice, it turns out to be very helpful to be able to assess what is driving the aggressor’s behaviour – but a different language is necessary. Here I am suggesting that we label aberrant behaviour as either: Dysphoric, Psychotic or Psychopathic. These are not mutually exclusive – obviously someone could, for example, be impassioned through a delusional belief system. The important practical question is – what is is driving the behaviour? If, somehow, we could remove the driving force, perhaps the behaviour would lessen?

These driving forces, I have briefly described below (their intricacies we will explore later)

DYSPHORIC BEHAVIOUR
This is the most common form most people will encounter. It is fueled or driven by emotion (usually unpleasant and several). It happens because the principal prontagonistics are overcomed by anger, frustration, humiliation, annoyance, irritation, euphoria, etc – and these overide thoughts or other considerations.
PSYCHOTIC BEHAVIOUR
Mental health issues affect one in four of us. It is important to notice also that 80% of violent crime is perpetrated by people with no psychiatric history – alcohol is by far the best predictor of violence. Most psychiatric patients are more worried about what others may do to them than what they may do to others. None-the-less, violence does occur when people become disturbed though drugs, severe intoxication or florid psychosis – and here it is often the fear of the unknown rather than the actual danger that fuels our concerns. The driving factors are confusion, delirium, delusions, hallucinations. Each may be associated by terrifying and potentially violent outcomes, but the question we have to ask is “what is the driving force?” For example, what would be most effective – dealing with the “voices” or reducing the anxiety?
PSYCHOPATHIC BEHAVIOUR
This is behaviour primarily driven by a goal which in the perpetrator’s mind supercedes all other consequences. Often professional criminal activity is ascribed to this grouping. It is important to understand that we are not talking categories of people here, only of behaviour. I don’t suspect that Wayne Rooney considers the feelings of the opposition’s goalie as he slams the ball into the net! This behaviour is primarily predatory but could equally apply to white collar business people and not involve any interpersonal violence.

There is still much more to know! In the next Masterclass we will explore the relation between Dissociation and Violence, and then following that Violence, Dissociation and the Brain. Then we can begin to put the whole picture together again and describe, in detail, good effective practice in violent dyadic situations. From there we will consider issues such as gang/group/ violence, bullying, crisis teamwork skills, personal control issues, post-incident reactions and support – interspersed with with anything interesting and relevant I can throw at you!

Hasta la vista!
Dr Iain Bourne
IMPACT Training & Consultation Ltd
E-mail: impact@dangerousbehaviour.com
Web: www.dangerousbehaviour.com

Filed under: Impact Training, Violence, psychosis , aggression, Bourne, Dangerous, Difficult, Disturbing, Dysphoria, Dysphoric, IMpact, Psychopathy, psychosis, Psychotic, Psychpathic, Violence

The Dangerous Behaviour Masterclass 2 – Violence and Beyond

Our courses go by the title “Difficult, Disturbing and Dangerous Behaviour” because terms like “Managing Aggression” or “Personal Safety Training” or “Dealing with Challenging Behaviour” fail to reflect the depth and breadth of what is covered. My interest is to help practitioners find the most effective and practical skills and  strategies for dealing with their greatest concerns about their own safety. For a start, “violence” is neither a unitary concept, nor all-embracing. Consider the examples below:

1. Domestic violence

2. A drunken brawl

3. A gangland shooting

4. Self-defence

5. Violence carried out by soldiers in the line of duty

6. Organised fights – e.g. Boxing

7. Violence caused by following a psychotic command hallucination

8. Violence borne out of frustration

9. Instrumental violence to achieve a particular end.

10. Accidental violence borne out of panic or confusion

11. Violent bullying

12. A revenge attack

13. Football hooliganism

Clearly all of these could be called “acts of violence” but the differences are huge. Furthermore, often we are not actually talking about violence itself, but the fear of violence. If we only think about the violent act, what about threats and intimidation? We have to think , not only about the behaviour of the perpetrator, but also the experience of the victim.

It has also struck me that “difficult behaviour” is different from “dangerous behaviour” not only in the degree of risk, but also in the form, principles and process involved. Certainly “difficult behaviour” – if not effectively contained – can become “dangerous behaviour,” but my observation is that when it does, it does so at a discrete point and at that point all the rules change. Later in this Masterclass I will expand on this point, or shift, in greater detail (see The Vacuum Concept). At this stage suffice to say that difficult behaviour refers primarily to situations where the behaviour of both perpetrator and respondent can be mediated by thought – i.e. it is possible to think before you act. Dangerous behaviour takes over when the events either overwhelm cognitive processing, or occur at a faster rate. Think of slipping on a banana skin – certainly dangerous because it can cause serious injury – but by the time you start thinking about it you will be on your backside! So somehow evasive action has to precede thought.

Most training within this domain is either restricted to difficult behaviour, or assumes that the only skills we can develop in relation to dangerous behaviour are preventative (risk assessment, lone-worker policies etc), or physical (breakaway, restraint etc). Important although these may be, this Masterclass will take us beyond that restricted view and into what some might say is the unknown or unknowable. What do you do when there is no time to think, no margin for error, and when your body seems to be operating with a “mind” of its own? We are talking about sitautions where people often say “every situation is different”, “you never know how you will react until it happens” , “there are no rules”, “what might work for me , today, may not work for you, tomorrow”, “there are just too many variables to take into account.” We will see!

But what about “disturbing behaviour?” Most of us have an intuitive understanding of at least some of the rules involvd in responding to someone who is behaving aggressively, and feel quite at sea when the aggressor is drunk, delirius, high or psychotic. So this is the other dimension of our Masterclass.

In  the next Masterclass we will look at what I have labelled respectively, Dysphoric, Psychotic and Psychopathic behaviours. Until then, stay safe!

Iain Bourne, 11.01.2008

Web Site: www.dangerousbehaviour.com

E-mail:     impact@dangerousbehaviour.com

Filed under: Impact Training, Violence, psychosis , aggression, challenging behaviour, dangerous behaviour, difficult behaviour, disturbing behaviour, personal safety, the vacuum concept, Violence

The Dangerous Behaviour Master Class – Introduction

Over the next few weeks and months I will be writing a series of short postings covering the breadth and depth of Difficult, Disturbing and Dangerous Behaviour. Although the primary focus will be on helping practitioners deal with the interactional aspects of responding to people, situations or behaviours that pose a serious risk, I will also be covering all aspects of theory, research and policy.

In addition to reading the postings you are also warmly invited to post your own comments, questions and feedback.

This is a non-profit venture and nothing is asked in return. The idea is to make available information that cannot be found elsewhere either in the professional literature or on the web. I hope that you find the postings interesting, informative and helpful!

These postings can be accessed here at the dangerousbehaviour.com website, or by subscribing to the IMPACT News RSS Newsfeed.

Best wishes

Iain Bourne

IMPACT Training & Consultation

“responding to violence, suicide, self-harm, psychosis and trauma”www.dangerousbehaviour.com

Filed under: Impact Training, Suicide, Violence, psychosis, trauma , aggression, dangerous behaviiour, dangerous behaviour masterclass, DDDB, personal safety, Violence

Mental health: training staff and users together – Kelvin Barton

Posted: 27 September 2007 | Subscribe Online

writes Anabel Unity Sale

Kelvin Barton is used to being different. For a start an impressive proportion of the 33-year-old’s body is covered in an array of colourful and intricate tattoos, as well as eight piercings. Becoming a social worker was not what Barton initially planned to do with his life. After leaving home at 16 he was homeless for a year before training as a tattooist and body piercer. But he doesn’t see the leap from body artist to social worker seven years ago as a huge one: “Bedside manner in body art is crucial and I had a lot of transferable skills in keeping people calm.”

These have proved invaluable in his role as mental health services co-ordinator for Providence Row Housing Association. And it is here that he has shown he can make a difference by introducing innovative training for staff and service users alike.

Based on Bethnal Green Road in East London, the housing association provides accommodation ranging from hostels to supported housing for 600 people who are homeless or likely to be homeless in London. As part of its Grounded Initiative the housing association has been piloting mental health training for services users and staff to attend together.

The idea stemmed from a request from a resident for awareness training in mental health. As it is Barton’s responsibility to source training for his colleagues, he decided to extend it to any interested service users. “It hadn’t been done here before and I thought it made absolute sense to train people together,” he says.

An added impetus for the joint training was a mental health workshop run two years ago for all the housing association’s staff – not just those in front-line positions – that was well received. One outcome Barton wants to achieve via the joint training is a reduction in the stigma associated with mental health issues and a better sense of integration among clients and staff. “I want to reduce the ‘them and us’ mentality. We are all working and living in this environment and the better we can understand each other and what we are trying to achieve the nicer the place will be.”

Barton decided to use trainer Iain Bourne because he had been trained by him before. “Iain was the first person I thought of because his style is fantastic and very engaging. I wanted to find a trainer who had a flair for training contrasting people, who didn’t just have a flipchart that said, ‘this is the diagnosis’. That’s fine if you’re studying for a doctorate but I wanted it to be more interactive. So people thought outside of the diagnosis – they saw the person holistically.”

The first training session took place in February and was on mental health awareness and covered legislation, how the system operates and people’s experiences of being in the system. Of the 18 people who voluntarily attended, half were service users and half were staff from different departments in the housing association.

In July, a second workshop was run on depression and anxiety, and again 18 people attended, split equally between professionals and users. And last month, a third session on anger and frustration was run with a focus on how these feelings manifest themselves both in a working environment for the professionals and a home environment for the residents and service users.

Ensuring that clients were not treated differently from staff during training was essential, Barton says. Each have experience that the others can learn from and training together helped people bond, he adds.

One of the housing association’s support workers who attended the depression and anxiety workshop says it was a fantastic idea to train staff and clients together:

“This was the best part of the training for me for many reasons. First, it seemed useful for clients suffering from these problems as it gave them helpful information and advice. Second, clients’ accounts and stories in the subject enriched the overall training for staff as these were real-life examples.”

He adds that completing the training with his client strengthened their working relationship because they experienced it as “equal members”.

TRAINING TIPS

Tips for training services users and professionals together on mental health issues.● Provide interactive training to engage people and use different techniques for different people. ● As a trainer use examples from your own professional experience. ● Acknowledge that professionals work in different ways and try to incorporate something for everyone into the session. ● Acknowledge those you are training have a wealth of knowledge, be it professional or as service user, so do not patronise them. ● Do not make assumptions about what a mental health diagnosis tells you about a person as circumstances can vary. ● Support the person rather than their mental health diagnosis.

Contact the author
Anabel Unity SaleThis article appeared in the 27 September issue under the headline “In it together”

Filed under: Impact Training, psychosis

Mental Health Service User Involvement – Community Care 27.09.2007

Providence Row’s Mental Health Co-ordinator, Kelvin Barton, has been taking user-involvement to a new level. Usually user-involvement refers to increased levels of consultation and representation in decision-making processes. Sometimes users can “graduate” into helpers or even become staff. Many MIND groups even make their staff training sessions available to the more able of their service users.

Kelvin’s idea, however, is that the people who would benefit most from mental health training are the users themselves – not only do they have the greatest curiosity about their own condition, but they also have the greatest need to understand the issues faced by their service users. Kelvin invited us to deliver this training – professional training which cuts out the professionals and goes straight to the service users. This is a quite different concept to that of group therapy or self-help groups (e.g. Hearing Voices, Depressives Anonymous, etc.) and takes the copncept of empowerment to another level.

 So far there have been courses on “Experiencing Mental Health Issues”, “Anxiety and Depression”, and “Anger and Iritability.” Essentially these are the same courses that would have been delivered to professional groups except instead of giving advice on helping others, there is a much greater emphasis on self-help.

 The article appers in CommunityCare on 27th September 2007

Filed under: Impact Training, psychosis , community care, Impact Training, mental health, service-users