Summer 2000, Vol. 8, No. 3.

Workplace Psychiatric Interventions:

Assessing an Employee's Threat of Violence

By Stephen Heidel, MD, MBA

Scope of the Problem

Employers are now alert to incidents of workplace violence committed by one of their employees or a former employee. In fact, many employers are concerned by these acts and are taking steps to manage threats as they arise and before serious harm occurs. It is not surprising since 15% of all violent crimes occur at work and approximately 1,000 employees die each year as a result of workplace violence. Violence is now the second leading cause of death in the workplace.

Warning Signs

There is a common myth that an employee who becomes violent just snaps without any warning or clues in advance of their violent acts. This is not the case. Usually there are warning signs by the employee before he/she commits a violent act. These warning signs include: 1) threatening comments; 2) threats to committing violence or murder; 3) reference to incidents of violence previously reported in the media; 4) stalking; 5) paranoia; 6) a history of violent behavior; 7) preoccupation or extreme interest in weapons; and 8) intimidation of co-workers. The following are examples of warning signs made by employees.

1. A man fell in love with a female co-worker. Initially the female showed interest then rebuffed him. He sent her cards and gifts and when she told him to stop, he began stalking her in the evening and on weekends. She confronted him in the workplace again telling him to stop. He told her he might not be able to control himself and made a gesture as though he was going to hit her.
   
2. A Customer Service Representative received several customer complaints about an employee's aggressive behavior. After an investigation the employee was transferred to a job in another department. He intimidated co-workers and there were several angry interactions with co-workers. He then filed a workers' compensation claim. After a short leave of absence he was released to return to work by the workers' compensation doctor. At that point he threatened to kill the workers' compensation physician.
   
3. An employee slammed equipment against walls when he was working near co-workers. He scared co-workers with talk of guns and of employees in the news who killed co-workers.
   
4. A man ended a relationship with a female co-worker. There were numerous exchanges between them after the relationship ended, including an e-mail from the woman to the man saying, 'I hate you. I wish you were dead. If I have the chance to make it happen I will.'
   

Workplace Response

Many employers realize they should not ignore events similar to those mentioned above. They are taking actions to deal with these threatening situations. These actions include:

1. Develop a violence policy stating there is zero tolerance for violent behavior and mandatory reporting of all threats of violence.
   
2. Establish a Threat Assessment Team, which may include representatives from Human Resources, Risk Management, Legal and the Employee Assistance Program.
   
3. Investigate threats by the Threat Assessment Team. The investigation includes interviewing the alleged victim, the alleged perpetrator and all witnesses.
   
4. Develop a plan of action. This may include requesting an assessment by the EAP if the threat is not considered to be a serious one. If the threat is considered to be serious, the assessment should be performed by a psychiatrist who is familiar with the workplace and knows how to perform a threat assessment.
   

The Role of Psychiatry

Psychiatrists may be well suited to assist in the assessment of potentially dangerous individuals. They can be helpful predicting imminent dangerous behavior, though they have not demonstrated an ability to make accurate predictions of long-term dangerousness. Psychiatrists also have experience evaluating many categories of violent-prone individuals. These categories include:

1. Psychosis (individuals with command hallucinations and persecutory delusions)
   
2. Depression
   
3. Mania
   
4. Posttraumatic Stress Disorder
   
5. Organic Brain Dysfunction (attention deficit disorder and brain damaged individuals)
   
6. Medical illness (hypoxia, hepatitis and renal dysfunction)
   
7. Stalkers
   

Psychiatrists also have experience evaluating personality traits. Certain traits are seen more commonly in violent-prone individuals. These include:

1. Impulsivity
   
2. Low frustration tolerance
   
3. Sense of entitlement
   
4. Suspicion about the motives of others
   

Prior to performing a threat assessment, a psychiatrist should be provided written documentation of the incident, information about the perpetrator's job performance and behavior on the job, and a description of the alleged perpetrator's job. The psychiatrist should speak to the workplace to clarify their expectations about the evaluation the psychiatrist is going to perform. The issue of confidentiality should be discussed with the referring organization so they will understand the nature of the information they will receive in a report. At the beginning of the evaluation, the psychiatrist should explain to the alleged perpetrator the purpose of the evaluation and ask him/her to sign a release of information consent form allowing specific information to be released to his employer.

Summary

Violent acts by employees in the workplace are common. Employers are more aware of these acts than ever before. Many have set up a system to investigate threats made by one of their employees. When these threats are felt to be serious, psychiatrists may be asked to perform a threat assessment and to make recommendations back to the employer.

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