#6. “Have an escape plan”

“I only had the experience of being truly afraid twice in my 40-year career. On the first occasion, a client told me that he was planning to shoot his wife with a gun that he had in the trunk of his car.

When I told him that I would have to warn his wife and call the police. He was very angry with me and left the office. This was after 5 pm when most of the people in the other offices had left work, so the building was almost deserted.

I did call both wife and police, but I was frightened when I left the office on the way to my car. However, thankfully, he was not there waiting for me in the parking lot. Nevertheless I checked the rear view mirror frequently on my drive home. He did not kill his wife, and he never returned.

On the second occasion, a very paranoid patient accused me of making sexual overtures toward him. He was a large and muscular person. He left the office angry and later that day punched a stranger who he passed on the street, accusing the person of the same. He ended up in jail.

I visited him there, but he refused to speak with me. On release from jail, he was transferred to an inpatient psychiatric unit. He was started on medication and was good for a while but went off his meds, hit another stranger, and was jailed again.

My advice for dealing with volatile people is that it helps to be calm, clear and direct with these people, and not to speak loudly. Make sure to have an escape plan and stay at the same level with patient. That is, don’t stand above him, which might be considered threatening or don’t sit when he is standing, in a more vulnerable position.”

#7. Just Tell Them

“It’s not a good feeling when your patients intimidate you. Fortunately, I learned how to deal with it early from a very good professor who said to me: ‘why don’t you tell them they are making you afraid?’

Once I did that, I was amazed at the results. I was shocked as to how oblivious some people are to how they come across to other people.

Helped me differentiate the really bad ones from those who had more of a conscience, empathy and self-control.”

#8. “People can change”

“Before I started my first job in mental health I did what any normal person would do: looked at forensic mental health stuff on the Internet. And through my perusal I found an incredibly detailed article about a young man who had gouged his own mother’s eyes out.

I read about it a bit, then set the paper aside and thought no more of it. The next week, I started my first placement on a psych ward.

I was introduced to the ward and the men that were in the unit. One of the young men in particular looked so familiar. But I didn’t want to ask colleagues because there can be issues if you know your patients personally (I thought I might have known him from school).

Weeks and months went by. I tried to just get on with doing my job, but this young man…I was so certain I knew him. I couldn’t get it out of my head.

I could have looked into his records, but I tried to make a point of not reading too much into patients’ personal histories because it can cloud your judgement.

But finally, I couldn’t bear it anymore. So I went and read his reason for admission. His crime: gauging out his mother’s eyes. It was him.

The guy I had read about before I started. My heart felt like it had stopped in my chest. I wanted to faint.

I was now petrified of him. I knew all the gory details of this guy’s crime. I knew his diagnosis. I knew everything. I was so scared every time I saw him that I could only smile and ask him feebly how his day was.

But, surprisingly, I’m no longer afraid of him. He’s a wonderful patient and he thoroughly enjoys the music therapy sessions we do weekly. He has responded beautifully, and he kind of taught me an important lesson that we all ought to remember.

Mental illness is not always a death sentence. People can change, they can improve. Sometimes they just need help from someone who’s not too afraid to be compassionate.”