What should we do when the patient attempts to harm other people?

It is very rare for mental health patients to harm other people; research found that the likelihood of them being violent is very similar to people without mental illnesses, and that most violence-related cases are not committed by mental health patients. However, it is possible for patients to feel that they are being harassed or persecuted due to their delusions and hallucinations, thus prompting them to be act defensively or take preemptive action, and this may be threatening to others. Also, the patient may become very sensitive or insecure, and misinterpret other people’s intentions.

If we notice increased frequency of the below behaviour by a family member, we should pay more attention to them and seek help from professionals as soon as possible.

  • Keeps pacing, being restless
  • Threatening, speaking with contempt or accusation
  • Agitated, shouting, hitting or throwing things
  • Clenching their fists, waving their hands

If we are concerned that the patient poses immediate threats to others, we can consider the following:

  • Contact the support units (i.e. social worker/professionals responsible for the case)
  • Slowly evacuate other people if necessary
  • Remain a physical distance with the patient (approximately the height of the patient with an added 1-2 foot)
  • Stand near the exit, making sure that the path is clear
  • Put your hands next to you so that the patient doesn’t suspect that you are armed
  • Avoid staring or glaring, maintain eye-level eye contact
  • Be soft spoken, speak with clarity and precision
  • Avoid speaking loudly or quickly
  • Do not provoke or blame (i.e. do not say things like “many people have had it worse”, “control your emotions”, “why are you doing this?”)
  • Do not get agitated, argue with the patient or attempt to take weapons away from the patient
  • Stay calm and friendly
  • Try to persuade the patient to sit down and put down the things they are holding
  • Do not reject requests that cannot be fulfilled immediately
  • If the situation is urgent, please seek help from the police by calling 9991
It is best to try and understand the patient’s perspective, and avoid provoking the patient; it is also advisable to seek help as soon as possible.

Seeking help for urgent situations

If the patient appears to be very emotionally unstable, posing threats to themselves or others, we can get help by calling an ambulance. We can be prepared for the situation by keeping the phone number of nearby ambulance/emergency medical services handy, so that we can call an ambulance when the above signs are showing. The ambulance staff would usually ask for basic information regarding the situation and then call the police for backup if necessary. If we don’t have the contact information for ambulances then, we can also call 999 directly and seek help from the police. It is important to remain calm, give your name, location, phone number, the patient’s emotional state and relevant problems etc. clearly on the phone.