This is a final draft of a chapter entitled: "Violence at Work: Causes and Protection" in to be included in Workplace Psychopathology: Recognition and Adaptation, edited by Thomas, J. and Hersen, M. (to be published in 2004). VIOLENCE AT WORK: CAUSES AND
PROTECTION "One cannot truly predict
nor prevent violence…However, one Now that the world and the workplace have moved into the 21st century, there is increasing awareness of changes in individuals, families, communities, countries and the workplace. Change leads to stress, and stress produces reactions. The majority of people cope quite well with the stresses of their lives; however, some people become overwhelmed and develop reactions that are maladaptive in nature. While there is mounting concern about workplace violence, it should be understood that this is but one way that people evidence pain, anguish and suffering. Substance or alcohol abuse, marital/familial, financial or emotional problems, and physical impairments are known to develop if people cannot manage the stresses of their lives. These maladies cause significant turmoil in personal as well as professional lives and place the individual (and the workplace) “at risk” for more severe difficulties. "Violence in the workplace" has become a familiar phrase in the modern day employment setting. Reports have been coming fast and furious from a variety of sources citing stories and statistics that increase alarm, anxiety and apprehension. Statistics are reported in the media that purport a dramatic increase in violence in the workplace. Certainly, one should be concerned about these reports and should make every effort to respond whenever possible. However, this response should be done in an effective and proactive fashion that does not escalate the issue with hype and hysteria! It must be remembered that as tragic as a violent episode may be, it is still a low frequency occurrence in the workplace. The National Institute of Occupational Safety and Health reports data indicating that the number of workplace homicides dropped from 929 to 757 between 1980-1992. (NIOSH, 2003, ¶ 1 & 2). Further, this report indicate that 75% of these workplace homicides are committed as part of a robbery by an unknown assailant and that only 4-6% of homicides in the workplace were committed by coworkers. (NIOSH, 2003, ¶ 11). Finally, NIOSH and the CDC suggest that there are more than 1 million non-fatal assaults in the workplace each year. However, this only represents about 18% of the total acts of violence per year in the United States. (OSHA, 2003, ¶ 1-3). The Department of Justice data reports that between 1993 and 1999, the number of non-fatal assaults decreased by 44% while workplace homicides dropped by 39 percent. Eleven percent of these homicides were committed by coworkers, former coworkers or customers (Bureau of Labor Statistics, 2001). There were 639 homicides in the workplace in 2001, down from the 677 homicides that took place at work in 2000. (Bureau of Labor Statistics, 2002) Although the data may vary as a result of reporting discrepancies and other factors, the numbers indicate that, in fact, the workplace is a relatively safe environment when compared to the streets and homes of America. Compared to feudal systems, slavery, sweatshops, "pre-unionized" factories and farms, the worker of today is at much less risk of violence, injury, discrimination or harassment. The last fifty years have seen laws and policies that have improved the quality, comfort and safety of most workplaces. The focus of any workplace should be on maintaining job performance and improving safety… not on managing personality problems. However, the Occupational Safety and Health Administration (OSHA) has determined that "Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." 29 U.S.C. 654(a) (OSHA, 2003). In recent years, interpretations of this policy have come to include personal safety. It is essential that supervisory personnel be trained to recognize whether an employee is capable of conducting him/herself in a safe and non-hostile manner. The forward thinking workplace has instituted workplace violence policies that are similar in scope to sexual harassment policies and protocol. The goal is to have today's work environment continue to provide an increasing level of safety and security. To do so requires that professionals from all “walks of life” work together to communicate accurate information, to contain and direct the anxiety and apprehension, and to be a proactive and highly visible resource to the total organization. There is no guarantee of one hundred percent prevention, but there is much that can be done to enhance safety and protection. The Ability to Predict Violence Predicting violence can be compared to forecasting tornadoes. We may understand the causes and conditions that precipitate a tornado, but we cannot truly know if, where or when it may actually occur nor how bad the resulting damage. However, clinical research and experience have developed a significant body of data that can facilitate a tornado warning or watch. As Michael Miller, M.D. (2000) writes in his article, “A Model for the Assessment of Violence” in the Harvard Review of Psychiatry: “We can identify populations more likely to be violent, but we cannot predict the specific risk for a given individual (p. 299-304).” Research on individuals who have committed heinous crimes has generated most of the data that we have about predicting violence. By extrapolating from these individuals, efforts have been made to develop a series of risk factors. These “warning signs” or “signals” may correlate with dangerousness or a propensity for violence; however, there are no absolute predictors. Ultimately, this list of characteristics is expanded into a “profile” in an effort to gain a clearer sense of who may act out in a hostile and/or violent manner. Table 1 represents the list of warning signs that have been presented in a wide range of documents from respected clinical journals to news magazines, websites and business newsletters (Lewis and Zare, 1999). __________________________________________________________
Insert Table 1 about here __________________________________________________________ As with any profiling, there is valid information that may portend a wide range of extreme and inappropriate behavior including, but not limited to, hostility and violence. However, as with any profiling, it casts too wide a net. People who share some of the characteristics may be included, but will never act in a violent or hostile manner. Further, many of the “characteristics” are psychosocial data that are personal and private and may not be known to the workplace. Therefore, while this is useful information for a clinician to include as part of a comprehensive evaluation, it should not be oversold as the absolute evaluation. Further, this information, placed in the hands of untrained non-clinical management personnel, may lead to inappropriate administrative actions on their part, or, at least it may heighten the state of anxiety that there is a “potentially violent individual” in the workplace. The harsh reality is that any workplace probably has its share of potentially violent individuals, but who do not evidence any of the “signs or signals.” Rather than attempt to profile based on private information, another way to assess someone’s risk to act inappropriately is to observe his or her daily behavior and relationships. Utilizing the following mnemonic provides some of the key observational factors. Characteristics of “TICKED” Individuals THOUGHT PROCESS- Does the individual evidence difficulties with his/her thinking and communication? If so, this could be due to psychosis, personality disorder, paranoia, toxicity, fanaticism, head injury interfere with the cognitive process. ISOLATION- Does the individual evidence a restricted social network with limited contact with family, friends, religion, and work? CONTROLLED by circumstances- Does the individual talk of feeling trapped, legally, financially or in his/her career, etc.? Does he/she see others as having power over his situation? KICKS- Is there evidence that the individual uses drugs, alcohol, gambling, or other hi-intensity, “action-oriented” or compulsive behaviors to manage anxiety? EMOTIONALITY-Does the individual evidence extreme emotional lability, mood swings, displays of intense emotions? DEFIANCE, DYSFUNCTION- Does the individual believe that the regular rules of society do not apply to him/her or the situation? Or, is his/her lifestyle characterized by chaos and instability. Once again, one must be cautious not to profile or to overreact, but to recognize that these are characteristics of an individual who may be prone to act inappropriately to conflict or stress in his her life. Definitions of nuisance, conflict, hostility and violence One of the difficult aspects of dealing with workplace hostility is that terms and phrases are used rather generically with only a superficial understanding of the concepts. I use four different definitions when dealing with workplace violence: Nuisance, Conflict, Hostility, and Violence. It is essential to have a basic understanding of each as they represent different levels of intent. In Workplace Hostility: Myth and Reality (Lewis & Zare, 1999), the authors define behaviors as follows: “Nuisance behavior may be annoying and offensive to others but does not have any direct malicious intent to a specific individual or group. Examples might be offensive gestures, swearing, off-color jokes and graffiti. While such behavior may be bothersome and disgusting, it is more a function of immaturity or poor socialization than of violence (p. 8).” “Conflict refers to the normal disagreements that take place in all interpersonal relationships. Whether personal, political or professional in nature, conflicts may be heated and intense, but do not result in permanent damage to the relationship (p. 8). However, if conflict continues unabated, it may result in damage to the underlying relationship, thus opening the door to the next level of hostility. Hostility refers to “acts that are nonphysical but are directed at an individual or group with the intent of inflicting some type of emotional harm.” Examples of this are harassment, discrimination, stalking, verbal threats, comments, acts of intimidation, etc. The defining characteristic is that there is no bodily contact or destruction of property. However “Violence involves the display of physical force against a person or property with the intention to do personal injury or destruction to property (p. 8).” While all hostile acts may be viewed as a violation and should certainly not be tolerated, there must be delineation of different types of behavior, rather than lumping them all under one label. Each type of act represents a particular intent, level of control, level of legal/criminal involvement and potential disciplinary outcome. Although time and space do not permit a full discussion, it is possible to see the distinctions between different types of behavior and different circumstances: writing racial or sexual epithets in the men’s room that are not directed to any specific individual is not the same as making a direct slur against a specific employee. Or, as offensive as yelling and swearing at another person may be, it evidences a different level of control than physical assault. Is the behavior overt or is it passive aggressive in nature? Does the person yell and scream and then leave the workplace, or do they remain and continue to intimidate others? Is an incident a “conflict” between two colleagues with a pre-existing positive regard for each other that has escalated into a loud and heated exchange… or is this an escalation between two people whose minimal tolerance for each other has reached a breaking point? The behaviors must be viewed within a multifaceted context that includes social, psychological and culture factors. Dynamics in the workplace As the preceding discussion suggests, the current tendency is often to look solely at the individual rather than in conjunction with the environment in which s/he works. However, as anyone knows, the American workplace is now and always has been fraught with some degree of tension and turmoil. Religious, ethnic and gender diversity, organizational transitions, and economic fluctuations create a dynamic environment that is constantly exerting pressures on an ever-changing workforce. Since WWII, the U.S. has experienced a significant transition in the demographics of the workforce. “Compared to three or four decades ago, the U.S. workforce is composed of more women, more minorities, more immigrants, more nonunion workers, more service workers, and more educated workers.” The number of women workers accounted for only 32 percent of civilian workers in 1948 grew to 60% by 2000. In 1960, foreign-born individuals made up 5.9% or the population. Within three decades, foreign-born workers make up almost 13% of the workforce. Further, the number of workers over the age of fifty-five will grow by 48% between 1998 and 2008. (Schaffner and Van Horn, 2003). The development of policies around ethnic diversity, sexual harassment, affirmative action, Americans with Disability Act, bilingualism, reflect this growing change in the “face” of the American workforce. With these changes come a variety of issues, conflicts, and concerns that get played out on a daily basis in the workplace and in the courts. Add to this picture increasing demand placed upon the individual workers. For many, the forty-hour work week has been extended, while lunch and personal breaks have been shortened. “Workers in the United States average more hours per week on the job than any other Western industrialized nation, according to International Labor Organization and United Nations data.” (Schaffner & Van Horn, 2003). Downsizing has resulted in a significant increase in the expected volume of work for the individual employee. The “social” time (chit chats, lunch breaks, water cooler gossip, etc.) that has been the necessary oil that lubricated the human equipment has been dramatically limited. The benefits, workplace social activities, and other aspects that were helpful in mitigating interpersonal stress have been cut back. The use of contingent workers and temporary employees has resulted in a workforce that does not always feel like a coordinated and committed team with a common goal. The advent of new technologies, most notably cell phones, pagers, and email, has blurred the boundaries between work and home and has, in many cases, turned the home or car into a second office. Even on vacations, many people check in with the office in order to keep up with the flow of work. Most high-level administrative personnel will agree with the aforementioned comments. However, they also will suggest that, with today’s economic flux, the reality is that we must continue on the course of running “lean and mean.” Be it in the public sector or private industry… schools or banks… insurance companies or software start-ups… the individual employee is the essential equipment and, in most cases, is working at an intense capacity. To understand workplace violence one must differentiate between the “at risk” workplace and the “toxic” workplace (Lewis and Zare, 1999). An “at risk” work organization is one that is vulnerable to hostile or violent activities perpetrated from outside the organization. The characteristics of such a work setting are described in Table 2, Examples of at risk workplaces are: convenience stores, liquor stores, taxi drivers, gas stations, etc. The usual types of hostility or violence perpetrated in these types of establishments are robberies. These incidents are usually committed by an individual who is unrelated to the workers or the workplace that (s)he is robbing. Further, if a homicide does result, it is usually not intended nor premeditated. The primary motivation is to get cash, drugs, or contraband and to get out of the establishment as quickly as possible. Simply put, the only method to lessen the vulnerability of an at risk workplace is to improve security (OSHA 2003. ¶ 6-10). __________________________________________________________ Insert Table 2 about here __________________________________________________________ The “toxic” workplace is one that is vulnerable to hostility and violence generated from within. Characteristics of a toxic workplace are listed in Table 3. Many may say that these characteristics are common to most workplaces. Given all of the factors that were discussed in the earlier portion of this chapter, it is true for many organizations that a certain level of dysfunctionality should be expected. Using the metaphor of a chronic medical problem, such as hypertension, may help to illustrate the insidious nature of workplace toxicity. The development of increased blood pressure is often the byproduct of aging, heredity, and lifestyle. An elevated blood pressure develops over time and is “quiet” with few obvious symptoms. Hypertension is known to be involved with a wide range of health problems such as headaches, heart disease, strokes, etc., that may result in grave illness and possibly death. It is recommended that people have their blood pressure monitored and, if it is above a certain level, life style recommendations (diet, exercise, decrease in salt, alcohol, etc.) may be suggested. If these do not provide the desired remediation, then medication is often introduced as a simple and effective method to contain the condition. In much the same way, workplace toxicity may be seen as a chronic condition that might develop in many work organizations. In the workplace, the “aging” factor may reflect issues such as the growth or diminishment of the specific industry, the economy, market fluctuations, etc. “Heredity” may be viewed as the workplace demographics and culture and the dynamics that are generated as a result of its unique “gene pool.” “Lifestyle” may loosely reflect dynamics and behaviors that result as the organization tries to cope with its aging process and inherited predisposition with events such as relocations, downsizing, demographic shifts, etc. Table 4 may be viewed as a combination of these Heredity and Lifestyle characteristics. Continuing to follow the metaphor, the organizational toxicity may begin to elevate in much the same way as an individual’s blood pressure, leaving the organization vulnerable to a wide range of serious health risks. Similarly, an organization should be monitoring its blood pressure, however, it is not as simple as rolling up a sleeve and applying a pressure cuff to one’s arm. However, Table 4 lists the type of events and incidents that this author to increase the organizational vulnerability to an increase in toxicity and thus an increase in the potential for a wide range of negative and inappropriate reactions that may include hostility an believes may violence. In much the same way that hypertension is described as a “silent killer,” most of these events are gradual shifts and changes that may not be acutely noted, but rather experienced as a gradual downturn in employee productivity and morale. __________________________________________________________ Insert Table 3 about here __________________________________________________________ __________________________________________________________ Insert Table 4 about here __________________________________________________________ Solutions Policy and procedures As the workplace continues to become increasingly diverse and the customers it serves more varied; and as greater demands are placed on its employees through downsizing, reorganizations, mergers and such, oftentimes the pressure and stress are manifested in inappropriate behaviors. It is essential to set up specific behavioral expectations and guidelines to help employees understand that being cooperative, communicative and courteous remains a significant component of any job description. Administrative policies such as safety regulations, sexual harassment, no smoking, drug and alcohol, Americans with Disabilities Act (ADA), and the Family Medical Leave Act (FMLA) have developed over the past 25 years in an effort to improve both the physical and emotional safety in the workplace. However, often these policies are housed in the Human Resource Department and the employee handbook. So often, they are not discussed again unless an individual has made a significant breach of one of them. It is recommended that adherence to behavioral expectations be included as an essential function of any job description. Currently, most job descriptions focus on technical skills, training and/or knowledge and are vaguely worded. Some include an equally indistinctly formulated statement to the effect that the employee shall perform other duties and responsibilities as delineated by his/her supervisor. This common yet obscure wording of a job description may result in further confusion and conflict. Rather, job descriptions should include as essential duties and responsibilities definitive technical/professional skill as well as components such as the following: “This position requires that the individual be able to abide by the behavioral expectations (codes of conduct) as delineated in the employee handbook. Examples of these behavioral expectations include but are not limited to: safety, drug and alcohol, sexual harassment, absenteeism, sick leave policies, etc.”. In addition, it is recommended that the job description also include language to this effect: “This position requires that the individual be able to comport him/herself in an appropriate manner maintaining courteous and effective interactions and communication with other employees and/or customers”. Table 5 presents a list of behavioral expectations that may be posted in the workplace. __________________________________________________________ Insert Table 5 about here __________________________________________________________ Currently, many organizations tolerate a wide range of behavior that may be considered unsuitable for the workplace. This is usually as a result of it being considered separate and distinct from one’s job description and occupational performance. Certainly, as the workplace becomes increasingly diverse, as well as increasingly stressful, there is a need to have very clear guidelines regarding behavioral expectations. Further, employees at all levels need to see that the ability to maintain a certain code of conduct is an essential feature of any job. In addition, including this expectation in a job description would necessitate that supervisors discuss these matters with their supervisees as part of the regular review process. In other words, it keeps the “humanistic” qualifications of the job description on a par with the “technological” qualifications. Some may ask, well if this is included as part of a job description, how does it influence or impact ADA? ADA has become an increasingly complex issue since it was first implemented. It is not the goal of this chapter, nor is there time or space to develop all of the intricacies, twists and turns of the ADA policies (see chapter 14). However, it would seem that including behavioral expectations (or adherence to Codes of Conduct) as part of a job description would actually simplify matters regarding what is and is not a “reasonable accommodation.” Further, regardless of disability or protected status, tolerance of the aforementioned behavioral expectations would not be considered a “reasonable accommodation.” As an example, there may be an employee who is suffering from Bipolar Disorder. This illness may be characterized by extreme moodiness, irritability, emotional hypersensitivity, some paranoid ideation and hyperactivity (American Psychiatric Association, 2000 [DSM-IV-TR]). It is certainly not a reasonable accommodation to tolerate emotional outbursts, hostile behavior, or disruptions in the workplace. In this case, a reasonable accommodation may be to allow for flex time due to side effects of medication or for therapy appointments, or, perhaps, to accommodate through a change in the location of a workspace so as to lessen stimulation and distraction. In closing, professionalism should be defined as having both the training, knowledge, skills and experience to do the work, as well as the capacity to maintain behavioral expectations relevant to the workplace. Management training As described, the modern workplace is often a vibrant, living organism with tension and turmoil, agitation and apprehension, and conflict and confusion. This is the norm and to be expected, depending upon such factors as economic fluctuations, changes in employee demographics, and a myriad of other variables. Oftentimes, an individual employee may be under stress as a result of these workplace attributes, or due to personal issues in his/her own life. Nonetheless, the workplace has requirements and expectations. Supervisors and department heads are key personnel in the functioning of a work department. Using a military model, they are the sergeants and lieutenants of a platoon. They are often in the awkward position of having a lot of responsibility with limited authority. They are charged with monitoring the productivity of their supervisees as well as determining their level of compliance with the behavioral expectations as derived from the company policies and procedures. This may be a very daunting task given the current dynamics. Many supervisors are “promoted from within” the workgroup and often receive limited supervisory training. Further, they may be in a situation where they are now managing workers who, at a previous time, were colleagues. To further complicate matters, new administrative policies and procedures roll down the pipeline with the expectation of comprehensive implementation. Many first and second level supervisors do not receive adequate training or understanding of the policies and therefore have a difficult time enforcing the administrative “rules and regs.” In addition, the often times preferred method of supervision is to practice what I call the “50% rule:” If there is a problem and you ignore it, 50% of the time it will go away… the other 50% of the time it will get worse. Put another way, many supervisors often practice crisis management… wait until a situation becomes a crisis… then try to manage it. Either philosophy often may result in many situations escalating to a point of extreme stress for the individual, the supervisor as well as coworkers. The following example provides a demonstration of what typically may occur. Bob was a worker who had been with a small manufacturing company for about 3 years. His performance was “spotty” and he often came in late or called in sick. On two occasions, he was discovered sleeping in a small storage closet. On more than one occasion, he became very angry and verbally abusive with a coworker when he was confronted about not “carrying his load.” Coworkers in his department felt that he was difficult and would often avoid him at lunch break. Further, he would eat his lunch in his car and often came in with the smell of alcohol on his breath. His supervisor was relatively new to the position having been promoted about a year earlier. He had tried to joke and cajole Bob as a way to try to get him “on track.” The significant issue was that the supervisor, along with the rest of the work crew, was afraid of Bob as he was a rather large man with a history of barroom brawls, arrests for assault and battery and other types of disruptive incidents. The unspoken rule in the department was to tolerate Bob and try to avoid making an issue of his job performance difficulties. The hope was that he would move on to another job soon. As time went on, Bob’s behavior escalated as a result of his (third) wife leaving him. His drinking and absenteeism increased, and he was involved in a car accident and a breathalyzer test confirmed a high level of alcohol in his system. At this time the “house of cards” tumbled and the anger and frustration that had resulted from years of tolerating his behavior surfaced intensely and people were calling for his termination. Fortunately or unfortunately, it was determined that he could not be terminated because: 1) the incident occurred on his own time and away from work; 2) he was innocent until proven guilty, and even were he to be convicted and lose his driver’s license, he did not need a license to do his work; and 3) none of his job performance difficulties had been documented. He returned to work within two days and was the butt of comments and jokes which resulted in Bob and another worker getting into a physical altercation. It was determined that were he to be disciplined, the other employee would have to receive the same “medicine.” By the next day, the entire department was dysfunctional, and “crisis management” was in operation. One can only speculate as to what might have happened if :
First and second level supervisors need support and training around managing employees. Companies are often not willing or able to devote the time and resources to provide this type of training. Remarkably, an organization often will provide training for a new computer program that is being implemented or a new system to provide service. However, the value of training supervisors around the daunting task of managing a diverse workforce that is under a lot of pressure is not deemed a valuable use of time and resources. Further, the companies that do provide these programs do so in a limited manner, devoting 1-2 hours a year to a presentation by an outside resource. Often these sessions are of little value as the presenter will focus the program on the “warning” signs of potentially violent individuals. The message often creates a sense of profiling and paranoia, leaving the supervisors with the message that they should be able to diagnose which of their employees is about to “go off.” Mental health professionals spend years of school and training and are limited in their capacity to determine risk. However, somehow a supervisor with 1-2 hours of “training” should be able to make a determination. When I have conducted workshops on topics such as this, the focus is not on diagnosing personality problems, but rather on job performance. The “warning” signals of an employee should be addressed without the specific concern as to whether the risk is only violent in nature. An at-risk employee is defined as an individual who is evidencing indications of significant difficulties maintaining his/her duties and responsibilities. An at-risk individual is vulnerable to a wide range of both personally and professionally disruptive experiences which may include marital stress, medical problems, and job performance difficulties. Table 6 provides a list of signals, signs, symptoms of an “at risk” employee that should be addressed as early as possible (Lewis and Zare, 1999). __________________________________________________________ Insert Table 6 about here __________________________________________________________ A more effective model was implemented by an organization that has informal monthly lunch meetings with a HR representative where supervisors can meet and discuss employee issues as a group, giving each other feedback and suggestions. Discussion of policies and procedures, employee issues, management strategies are the focus of these sessions. Between meetings, supervisors feel free to contact each other to get feedback and guidance. Further, it has helped to improve the often ambivalent relationship between supervisors and the HR department. This author provides the EAP for this organization and was invited to attend one of the sessions to discuss the EAP and how to help employees who are having difficulty access its services. Another organization has an ongoing “university” where supervisors may enroll in a variety of courses that are specifically designed to improve management skills. Another educational system has a “mentoring” program in which a subordinate is paired with a senior administrative person for a year and spends regular time meeting around management issues and skill building. And finally, there is the concept of executive coaching. This is a training system where an individual has regular access to an outside professional who may provide phone or face-to-face coaching services. Unfortunately, theses services may be quite costly and are therefore usually limited to the senior level of personnel. In summation, supervisory training of first and second level managers is an essential investment in mitigating the impact of stress and therefore the possibility of hostility in the workplace. This training would focus on assisting supervisors in their ability to intervene with employees evidencing job performance difficulties. The focus should not be on just those employees where a fear of violence is the issue, but rather all employees showing signs of undue stress that affects job performance. Safety Teams Often a work organization will set up safety teams whose purpose is to look at the physical safety issues within a work environment. Initially the primary motivation for the formation of these teams was to lessen the accidents and injuries that resulted in worker’s compensation claims. When empowered and utilized appropriately, the efforts of these teams have resulted in lowered worker’s compensation as well as lowered accidents and injuries. It is the view of this author that the focus of these teams is somewhat restricted and should be broadened to include a wider variety of safety issues. Many of the policies that have been implemented in the workplace over the past twenty five years are actually policies that focus on personal and emotional safety. Drug and alcohol, sexual harassment, no smoking, racial and religious discrimination policies are all designed to improve the safety of the workplace. Further, it should be remembered that breaches of these policies may be defined as hostile acts within the workplace. With a broader perspective, teams should be formed with representation from all aspects of the workplace such as human resources, legal, security, EAP, labor, management, etc. By meeting regularly, they may keep their “thumb on the pulse” of the workplace and monitor all aspects of safety… physical, personal, gender, racial, religious, etc. Increasing safety is a proactive and preventative method of lessening harm from a wide range of sources including violence and hostility. Focusing on violence is merely a reactive intervention to an incident that has already occurred. Employee Assistance Programs EAPs were first utilized by large and small businesses during the 1980s. Originally designed to provide assistance to employees with substance and alcohol problems, they soon developed a “broad brush” orientation to a wider variety of emotional, legal, and family related concerns. EAPs are described in detail in chapter 18, so this chapter concentrates on an EAP in controlling hostility and violence. A comprehensive EAP should provide the following services:
An EAP should either conduct or have professionals available who may conduct fitness for duty evaluations of individuals who evidence severe dysfunction. As indicated earlier in this chapter, the focus should not be just on concerns about potential violence, but rather on providing the needed services for any “at risk” individual and his/her family. A well-utilized EAP is an essential feature in: 1) responding to stress in the workplace, 2) training supervisors; 3) providing interventions for those employees who are experiencing difficulties; and 4) providing crisis intervention if and when an incident occurs. At Risk Assessments: Fitness for Duty Evaluations As work organizations and the mental health field attempt to respond to hostility and violence in the workplace, they often fall back on old methods of intervention. What must be recognized is that the current workplace dynamics require a new response to an increasingly complex milieu. The terminology "fitness for duty," originally taken from the medical model to evaluate physical/medical impairment/illnesses, has been utilized to assess mental conditions. Currently, there are a variety of terms used when describing these types of extensive evaluations: fitness for duty evaluations, forensic evaluations, independent medical evaluations, threat assessments. A brief review will suggest that these terms no longer have the right “fit” for the types of evaluations that are being requested or required to determine emotional fitness for duty. Fitness for duty originally generated from the medical model referring to physical injuries. As an example, an individual may have broken his arm, and a physician determines when the arm will be healed sufficiently and will be fit for duty. Or, as another example, an individual may have suffered a heart attack. In either case, the damage as well as the recovery may be objectively monitored and measured. With broken bones or damaged hearts, it is easier to diagnose and predict the course of treatment and resolution. The vagaries of emotional and psychological disorders are not as easy to formulate and determine. Thus, the medically oriented term fitness for duty evaluation is not an appropriate label. The label forensic is used when pertaining to criminal/legal situations. A forensic investigation is the gathering of evidence at a crime scene by law enforcement personnel. Forensic evaluations may be used to determine guardianship in divorce cases or to evaluate the state of mind of the perpetrator of a crime. An Independent Medical Evaluation is self-descriptive. It usually involves cases where there is a disability and/or insurance settlement to be determined. At times, the results of an initial medical evaluation may seem to be biased either in favor of the employee or the employer. In these cases, a mutually agreed upon professional may be called upon to make a judgment in order to resolve the issue. Threat Assessment is a recent designation that has developed primarily in the workplace when an individual has behaved in a manner that is threatening and/or violent. It often involves a team or committee of personnel from the workplace who determine if there has been behavior that warrants administrative intervention. Often, this intervention will include an evaluation of the individual. As mentioned earlier, there are many other situations where an individual may have behaved in a significantly inappropriate way, but never uttered or demonstrated any hostile or violent behavior. Nonetheless, an evaluation should be conducted, but it would not be a threat assessment. The term “At Risk” Assessment seems to be a more accurate term to describe both the individual as well as the process. Further, none of the aforementioned labels would apply to an individual who is exhibiting psychotic behavior or mental confusion. Or, in the case of someone who has been doing his/her job, but makes a veiled threat of violence, none of the terms would be a suitable assignation. As will become increasingly clarified throughout this book, it is our philosophy that a person’s inappropriate behavior should be viewed as a sign or symptom of distress and disturbance. Certainly, the workplace cannot tolerate or condone this behavior. These individuals are at risk to themselves as well as others and that intervention is required. In closing, it is not a simple task to define and diagnose the issues of workplace violence. It is a complex undertaking that requires devoting attention to: the job performance and behavioral expectations of the more than 150 million workers in America, the workplace culture and dynamics, the changes in employee demographics, the development and implementation of policies and procedures, improved training of supervisors, the early intervention with employees who are “at risk.” References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Revision). Washington, D.C. Bureau of Justice Statistics (BJS) December 2001. Violence in the Workplace, 1993-99. Washington, DC: U.S. Department of Justice. Bureau of Labor Statistics (BLS). November 2002. BLS Survey of Occupational Injuries and Illnesses. Washington, DC: U.S. Department of Labor. Lewis, G. and Zare, N. (1999). Workplace Violence: Myth and Reality. Taylor and Francis, Philadelphia, PA. Miller, M. (2000). A Model for the Assessment of Violence. Harvard Review of Psychiatry, 2000, 7, 299-304. NIOSH. Violence in the Workplace: Homicide in the Workplace. Retrieved May 30, 2003 from http://www.cdc.gov/niosh/violhomi.html Occupational Safety and Health Association. Retrieved May 30, 2003. from www.osha.gov/oshinfo/priorities/violence.htm Schaffner, H and Van Horn, C. (2003) A Nation at Work. Rutgers University Press, New Brunswick, NJ. Table 1 The following represent the most often cited risk factors:
Other factors to consider are: lower socioeconomic status
Table 2: Characteristics of an “At Risk” Workplace
Table 3 Characteristics of a “Toxic” Workplace
Although these characteristics are often common to most workplaces, it is the level or the perceived intensity of these dynamics that generates toxicity. Further, there are common events that may exacerbate the toxic level of a workplace. Examples of these events are: Table 4 Events that May Increase Toxicity in the Workplace
Table 5 Behavioral Expectations: The 10 commandments of the Workplace This applies to all employees at all levels.
Table 6 Signs and symptoms of an at risk worker
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