Im David Smith

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• Im David Smith
• Early Intervention Team
• Assessment and therapeutic work with newly
  arrived people seeking asylum

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People seeking safety

• Their distress, including aggression violence
• the staff who work with them

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• Most mental health professionals would
• probably agree that asylum seekers must be
• treated with dignity and respect. But we are
• concerned that, in mental health, the
• tendency to describe asylum seekers as
• 'traumatised' and 'damaged' could add to
• their problems

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Stressors

• All the stressors of ordinary life
• Acute chronic somatic and psychic pain
• Racism xenophobia
• Homelessness oppressive housing and multiple
  dispersals
• Culture shock
• Delays and limbo
• Threat of detention, removal and return

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• Separation from and loss of family, home,
  culture, identity
• Loss of self
• Existential crises - who am I ? what meaning is
  there in this world anymore? Do I exist?
• Persecution, torture, and death of family,
  friends and colleagues left behind
• Uncertainty eg about asylum outcome detention
  financial support
• Loss of status role - idleness

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• Sharing rooms loss of privacy
• Anomie isolation
• Ill-health
• Destitution
• Feeling like a child language barrier
• Not knowing the system foreigness

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• Away from originating country, but still there.
• Threat of separation from children
• Fear of being found out
• Acute Chronic Post-trauma experiences
• Forced to be a victim dissonance
• Loss of political social activism and potency

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Case Study

• Mr Elongo

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General Principles

• THE BURDEN OF TORTURE IS NOT necessarily TOO
  GREAT
• EXPECT PEOPLE TO STAY IN CHARGE
• EXPECT PEOPLE TO THINK but help them

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K. Dunn et al. Issues in Mental Health Nursing,
28201217, 2007

• SELF-EFFICACY LOCUS OF
• CONTROL AFFECT MANAGEMENT OF
• AGGRESSION BY MENTAL HEALTH
• NURSES

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• There may be direct relationships among
• mental health nurses self-efficacy, their
• degree of internality or externality in relation
• to locus of control, and their ability to safely
• and effectively manage aggressive incidents

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Whats the jargon mean?

• Self-efficacy the belief in ones capacity to
  organise and carry out action to produce an
  outcome (Bandura, 1997).
• Locus of control concerns the personal
  attribution of lifes determiners to either
  internal or self-directed actions, or one of
  two dimensions of externality chance
  happenings, or actions of powerful others
  (Levenson, 1981)

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Stay in charge of yourself

• Calm, assertive natural, neutral voice
• Check immediate thoughts feelings
• Shake hands or otherwise greet
• Posture
• Eye contact direct? Intensity of gaze
• Containing gestures
• Expect client to be able to stay in charge

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Involve client

• I want to understand. Can you tell me whats
  making you so upset?
• Make assumptions about unmet need and ask are
  you also hurt feeling small very afraid at
  your wits end?
• You have to help me understand
• I dont mind if you shout or scream, but you
  mustnt hit me. OK?

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Eyes

• No pity!
• Fierce big afraid
• Intensity of gaze
• Looking away altogether
• Esp re solitary confinement interrogation

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Position Space

• Out of control? small space
• Fright persecution large space with easy exit
• Angle and stance
• Hyperarousal keep on the move?

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Use of others

• Family/friends enlist as mutual allies
• Colleagues/ interpreters
• Children
• Head of family

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Distress culture

• Is this normal for the clients culture
  experiences?
• Who should see the client? Male/female/black/white
  /age
• English or 1st Language?

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Aggression Violence occur in a context

• Ask and intuit the unmet need
• Hurt
• Powerlessness feeling small
• Panic fear threat
• Feeling unsafe
• Feeling like losing control
• Flashbacks
• Misplaced revenge

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Flashbacks

• Firm containment hold on tight
• Distraction from triggers avoidance
• Grounding
• Stay in flashback and talk through
• Prepare client for triggers
• If cant identify triggers repair/reassure
• Make assumptions ask mock executions solitary
  confinement.

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Caution!

• You need training and supervised experience
• Be aware of your own work setting
• General principles and a few tips only
• Take care of yourself