A Field Study Following the Death of a Community Mental Health Worker in a Consumer's Home

Background: Following the death of an experienced mental health case worker in Washington State in late 2005, a field study requested by the social worker's union, SEIU, Northwest 1199 was conducted. The purpose of the study was to examine the factors associated with the worker's death from the vantage point of the mental health system, the state occupational health agency, the consumers, the workforce, and the union. Methods: Between July 11-15, 2006 four focus groups and a series of meetings with mental health stakeholders in Washington State were conducted. Findings: A summary of the themes will be presented but include factors antagonistic to the therapeutic relationship such as high caseloads, burdensome paperwork, and highly stressful work environments. We also found that home visits are generally done alone (i.e. not in pairs), but visiting in pairs is considered much safer. There is cost pressure, however, for workers to visit alone. Clients are more acutely ill, more often have co-occurring substance abuse disorders, and are much more likely to be violent. Direct care workers experience a lot a violence including verbal hostility, threats, and physical assaults. It is difficult and sometimes impossible to obtain relevant information pertaining to a client's past history of aggression, assault, and criminal behavior. Staff safety training is critical, but many staff report receiving little or no safety training, inconsistent safety policies, or no regularity in training. Conclusions: Improved safety in community mental health is a function of staff caseloads, information availability, improved training, and targeted safety policies.