In the mental health facility I work in, there are unfortunately many situations that require intervention to calm an agitated person.
Because of the location and the purpose of my security department, I’m often directly involved in the calming process.
We admit many patients to the building through the core area I work in. Patients arrive by squad car or ambulance and walk, get wheeled, or are carried into our building.
We are a facility housing chronic, challenging, difficult, and high-security patients. 72 counties can send patients to our facility for review, evaluation, treatment, and care.
Many times, patients are scared, confused, angry, and even combative.
They arrive unsure of why they’re going to this facility and what they will face.
One older man with an obviously intense mental illness (obvious to me as a nonmedical staff member) was angry that he was being sent to a “mental hospital.” He didn’t see the need or reason. Therefore, he refused to get out of the transport van.
Since admissions are our responsibility, I got the call. We try to be ready for such circumstances. I gathered a team to deal with the situation. A gurney is always ready to transport those who are unwilling to walk. There have been a few times that one has been needed.
In this situation, one of the security officers began dialogue. Like many of our staff, he’s a first-generation immigrant, complete with an accent.
The incoming patient resented this, commenting something about “foreign” people. The situation appeared negative—it appeared that the officer’s message was not going to be well received by the patient.
As I mentioned in a previous article
, our response to this is to substitute someone else in the speaking process.
The patient was quite pointed in that there was something he wanted to say.
I always encourage patients to state what’s on their mind, as it seems to be better when they feel heard.
Even though what this man was saying was very manic and somewhat incoherent, I tried to work with what I could make out and use it to start a conversation.
I was able to build rapport with the man and gather that he was quite solid in his convictions, seemed very worldly, and was positive that he didn’t belong at this facility.
I told him that I could bring him to people who would be able to discuss his placement and help change it if needed. He was able to recognize that ours is a mental health facility. I told him that the doctors and nurses could help guide him in the direction that he wished.
I find that one has to be careful not to make judgments of right or wrong direction or make promises that cannot be fulfilled.
I can stand behind the fact that the courts have ordered this person to be here. I am able to tell the person that those who can help them live up to the mandates of the court order are in the building.
I did, in fact, tell this patient that, and reassured him that if he met with those who could help him and complied with what was expected, that his stay would be the shortest possible.
He was not thrilled with me, calling me a name at one point.
He did, however, comply with what we wanted and walked unaided through the whole building to get to his new unit. He seemed content that he had been listened to and that we were responding to his wishes.
I talked to him calmly, positively.
I find it helps to repeat the message in different ways. There has to be sincerity so you don’t come off as using a used-car-salesman approach. Our motto is “How can we help?” and that’s stamped on our ID tags. It could come off as cheesy, as that’s the same motto as a mega department store discount chain. But hopefully, the caring comes through in our speech.
The art of calming an excited person is learned through watching, listening, and reading relevant topics.
It has only been through CPI that I have been able to put together what I have learned in a single package.
It’s most helpful to have your entire arsenal of tactics and skills ready when a tense situation happens. Something will work. It’s just a question of what message and who will be listened to.
Even if you can’t prevent physical engagement with someone, the victory comes when the person’s anger is lessened, the fight doesn’t last as long as could be, and that a similar situation doesn’t happen again or as frequently.
James Spoerl is a 31-year veteran of the State of Wisconsin. He has spent 16 years in the Department of Corrections and 15 years with the Department of Health Services. He is a captain with the Mendota Mental Health Security Department. When he was young, he found disruptions thrilling and challenging. Now that he’s directly responsible for staff and patient safety, he uses every tactic he’s learned over the years to settle situations calmly and peaceably.