Problems relating to anger and aggression are not uncommon in AOD services and should be managed appropriately [1592]. Anger and aggression may occur regardless of whether a person has a co-occurring mental health condition. In general, episodes of aggression are usually triggered by a particular event, which may involve circumstances that have led the client to feel threatened or frustrated.
The following signs may indicate that a client could potentially become aggressive or violent [431]:
- Appearance: intoxicated, dishevelled or dirty, bloodstained, bizarre, carrying anything that could be used as a weapon.
- Physical activity: restless or agitated, pacing, standing up frequently, clenching of jaw or fists, hostile facial expressions with sustained eye contact, entering ‘off limit’ areas uninvited.
- Mood: angry, irritable, anxious, tense, distressed, difficulty controlling emotions.
- Speech: loud, swearing or threatening, sarcastic, slurred.
- Worker’s reaction: fear, anxiety, unease, frustration, anger.
If a client becomes aggressive, threatening or potentially violent, it is important for AOD workers to respond in accordance with the policies and procedures specific to their service. It is also important for AOD workers to have knowledge of how to respond to challenging behaviour, including physical threats or actual violence, in their work with AOD clients. Table 58 outlines some general strategies for managing aggressive clients. Beyond immediate responses that are described below, clients who have persistent issues with anger may benefit from anger management programs that promote the development of coping skills for anger regulation, problem-solving skills, and promote relaxation [1593, 1594].
Table 58: Dos and don’ts of managing a client who is angry or aggressive
| Do: |
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Stay calm and keep your emotions in check.
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Adopt a passive and non-threatening body posture (e.g., hands by your side with empty palms facing forward, body at a 45-degree angle to the aggressor).
|
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Approach the client from the front.
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Move the client to a place without an audience if possible, and try to reduce environmental stimulation.
|
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Let the client air their feelings and acknowledge them.
|
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Ask open-ended questions to keep a dialogue going.
|
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Be flexible, within reason.
|
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Use the space for self-protection (position yourself close to the exit, don’t crowd the client).
|
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Structure the work environment to ensure safety (e.g., have safety mechanisms in place such as alarms and remove items that can be used as potential weapons).
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Make sure other clients are out of harm’s way.
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| Don't: |
|
Challenge or threaten the client by tone of voice, eyes or body language.
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Say things that will escalate the aggression.
|
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Yell, even if the client is yelling at you.
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Turn your back on the client.
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Rush the client.
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Argue with the client.
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Dismiss delusional thoughts. These thoughts are real for the client.
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Stay around if the client doesn’t calm down.
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Ignore verbal threats or warnings of violence.
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Tolerate violence or aggression.
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Try to disarm a person with a weapon or battle it alone.
|
Adapted from NSW Department of Health [431] and Stone et al. [389].