Obviously prevention is better than cure and that it is easier to respond to a situation before it escalates. One problem with most formal risk assessments is that they take a long time to complete and require information that often isn't available. Another is that they are static and yet risk can change within seconds. Furthermore, many frontline staff work in situations where there an ongoing level of risk and unpredictability, where many things may be going on at the same time.
How to spot, then, when a situation is becoming critical? Well there are two fast methods:
Activation of the Sympathetic Nervous System
Noticing any unexpected or unexplained changes
Activation of the Sympathetic Nervous System: I will go into this in greater detail in a later blog. This refers to what is often described as "a gut reaction" "a feeling" or "intuition." Assuming that the staff member isn't struggling with significant psycho-physiological issues, it is fairly safe to assume that their body isn't reacting in this way for no good reason. It does so because the brain's "danger radar" and relay system - the thalamus (again more of this later) has spotted some form of threat, has decided to by-pass the frontal cortex (where we think) because thinking is too slow, sending the signal via the limbic system (the fast, lizardlike brain) to the adrenal glands where the stress hormones are released activating the Sympathetic Nervous System (The Go, Go, Go part of the autonomic nervous system). So if you get that "feeling" it may be the best and most reliable indicator that trouble is afoot.
Unexpected or Unexplained Changes: Even in very chaotic settings with people who may be in chaos, there is a sense of things being much the same as usual. Sometimes we encounter something that surprises us, that is not as we expected. Under our breath we may say "what?" "really?" or "oh!" These moments are often missed. They may not signal danger but they do signal something. Imagine working with someone who is flat, de-motivated, depressed and very hard to engage. Then at the end of a session when you are trying to agree the time of your next session they say "I can't make next week, cos I'm staying with my cousin." We could respond with "Oh I didn't know about your cousin, I'm pleased for you and I hope it goes well." How about the following week then?" Sounds reasonable but something has changed (how does this disengaged person suddenly find the wherewithal to negotiate everything that is entailed?) and this could indicate many things including danger to us, to the service user, to their cousin.
When the Amber Zone is suspected we should either "stop and investigate" or "withdraw and consult" but not "wait and see." How we go about this will be covered later in the blog.
Stay Safe
Iain