Workplace Violence and Trauma: A 21st Century Rehabilitation Issue.

Incidents of workplace violence are increasing and are often the focus of national news. On December 24th, 1997, at a Denver postal facility, a former employee took seven hostages and held them for ten hours (Duke, 1997). Elsewhere, other Denver residents were involved in deciding whether Terry Nichols should receive the death penalty in relation to the Alfred P. Murrah Federal Building bombing (Clark, Candiotti & AP, 1997). In Allentown, Pennsylvania a food service employee shot co-workers and then committed suicide on June 4th, 1998 (Associated Press, 1998). Only weeks later, on July 23rd, 1998, a newspaper worker in Michigan shot and killed the circulation manager(CNN). During the 1997 UPS strike, bottle rockets were fired at UPS trucks in North Dakota. In Massachusetts, strike-related activities resulted in one injury and two arrests (Flock & AP, 1997).

Meanwhile, in an unpublicized event, a worker's compensation/rehabilitation counselor working for a private hospital informed a hospital employee that he would receive lower compensation benefits than the employee felt he deserved. In retaliation, the employee stated that the rehabilitation counselor's car would be rigged with a bomb. The counselor reported the incident to her supervisor and local police were called to inspect the vehicle. The fearful counselor had her concerns discounted at work and, after three months of anxiety and depression, confided to a friend. Coincidentally, her friend was an expert in workplace psychological trauma and debriefing. The friend was able to provide debriefing and appropriate referrals for further psychological support.

Prevalence of Workplace Violence

In 1993, workplace homicides resulted in 1,063 deaths, averaging three people per day (Toscano & Weber, 1995). That year, another 22,396 people received injuries serious enough to result in time away from work (Toscano & Weber). Categories of violent workplace actions included in Bureau of Labor Statistics (BLS) are: hitting/kicking/beating; biting; threat/verbal assault; squeezing/pinching/scratching/twisting; shooting; stabbing and other (BLS, 1996). Northwestern National Life Insurance Company (NWNL, 1993) estimated more than two million workers were the victims of physical attacks at work between July 1992 and July 1993. Further, NWNL estimated another six million were threatened and 16 million harassed.

During 1994, approximately one million people were victims of violent workplace incidents at work, representing 15 percent of the victims of violent acts in the United States (Bachman, 1994). Women constituted 60 percent of the victims (BLS, 1996). In addition to these victims of violence, another 2.2 million experienced theft at work (Bachman). According to 1994 Department of Justice reports, (Bachman) 879,000 assaults, 13,000 rapes, and 80,000 robberies were reported and together on average resulted in five days of missed work per person (BLS, 1996).

In 1995, assaults and violent actions in the workplace resulted in 1,262 deaths, of which 10 percent were caused by fellow or former employees (Toscano & Windau, 1996). Nonfatal injuries resulting in time away from work numbered 45,800 (BLS, 1997, Dec). As previously mentioned, these figures did not include the numerous incidents which did not result in lost work time.

In 1996, assaults and violent actions resulted in the deaths of 1,144 individuals while at work (BLS, 1997, Aug). These homicides constituted 14 percent of worker deaths (US Department of Labor, 1996). Fifty percent of the workplace homicide victims were sales or service-related occupations (US Department of Labor, 1996). While more men were homicide victims at work, homicide was and continues to be the leading cause of death for women in the workplace (Toscano & Weber, 1995; and Toscano & Windau, 1996).

These figures do not include the numerous incidents that go unreported, which is estimated to be more than 50 percent (Bachman, 1994), nor do they include threats made at work. The primary problem is that when an injury incident does not result in lost work, it may not be reported to supervisors or public authorities; thus it may never be tracked and is all too often unaddressed. Bureau of Labor Statistics data, which is survey-based, includes incidents which result in a day or more away from work (BLS, 1996). Many more daily occurrences of threats to fellow employees are made which employees fail to report. Additionally, when equipment is sabotaged and causes injuries it may be difficult to assign responsibility for the action and intent to harm. Statisticians and researchers often fail to separate violence which occurs in the course of another criminal act, such as burglary, with violence which is directly tied to the work setting, making tracking difficult.

Workplace violence statistics are gathered from sources including compensation cases, medical examiners, Occupational Safety and Health Administration (OSHA) files, the press, etc. and often do not include workers such as the self-employed and government workers. For example, the Bureau of Labor Statistics compilation of fatal work injuries due to specific circumstances do not always include farm, sea, household employees, federal/state/local government, or highway deaths (Becker, 1997; BLS, 1996). Moreover, researchers suggest that the measuring of violent acts is vastly understated in that the figures do not reflect verbal, indirect, and passive aggressive behaviors which are more pervasive (Baron & Neuman, 1996; Elliot & Jarrett, 1994; Harlan, 1995). However, perhaps more than any statistical information, the widespread use and understanding of the phrase "going postal" points out the increased awareness and prevalence of workplace violence in our society.

Definition of Workplace Violence

The lack of a concise, clear definition of workplace violence is one of the problems in both tracking and addressing the issue (Keyes & Keim, 1996). Various definitions of workplace violence include both actual behaviors and threats to commit behaviors including: terrorist acts, harassment, physical assault, property destruction, intimidation, verbal assaults, robbery/theft, and domestic violence extending into the workplace (Baron, 1993; Baron & Neuman, 1996; Harlan, 1995; Kenwood Group, 1994). Keyes and Keim (1996) suggest that ambiguous incidents such as an employee who is berated in front of peers, sabotaged machinery which unintentionally injures an employee, or harassed employees who are later found assaulted or killed off workplace property represent often overlooked instances of workplace violence. It is helpful to differentiate between violence perpetrated by non-employees (i.e., robbery), violence perpetrated by customers/clients, and violence perpetrated by employees.

Victims, Locations and Costs of the Violence

NWNL (1993) predicts that by the year 2000 one out of every four full-time workers will be victimized by workplace violence. The cost of workplace violence is difficult to assess since the cost of human pain and suffering is immeasurable. However, in 1994, the cost was estimated to be 1.751 million workdays and $55 million in lost wages (Bachman, 1994). These figures do not include property damage, medical and psychological care, lost company goodwill, impact on employee turnover and hiring, etc. Potential liability costs to businesses for harm due to workplace violence are vastly different depending on the breadth of the definition, such as whether the business is liable for incidents occurring off the work site which are solely due to a work relationship or psychological harm to victims and witnesses. Buss (1994), using a broader definition of costs related to violence at work, reported estimates of crimes which caused injury at $202 billion. Further, damages awarded through litigation greatly increase costs to businesses ($1.8 million [rapes], $1.2 million [assaults], and $700 thousand [robberies] Buss, 1994).

Workplace violence occurs in a wide variety of settings and locations. Sixty percent of the violent acts occur in private companies, with 30 percent occurring in government jobs only, constituting 18 percent of the workforce (Bachman, 1994; & BLS, 1996). Nonfatal acts against women are 8.6 times higher in state government and 5.5 times higher in local government than in the private sector (Harlan, 1995). Companies that appear to have a higher probability of workplace violence include those with authoritarian management policies (Baxter & Margavio, 1996; Bensimon, 1994; Johnson & Indvik, 1994). Within this management style, employees do not feel free to participate in decisionmaking and view supervision as strict, unreceptive, and uncaring. Additionally, these companies often are understaffed with mandatory overtime hours (Bensimon, 1994).

Of particular interest to rehabilitation counselors, the highest industry rates for assault in 1994 were residential care and nursing home facilities (40 and 37 incidents per 10,000 workers respectively, BLS, 1996). Two-thirds of the work days lost by women in health care settings are due to injury by the very people for whom they are providing care (Harlan, 1995). Moreover, Harlan reports that four times more women than men are injured by their patients. Unfortunately, these attacks often are not reported because they are not viewed as crimes or the employer prohibits the reporting of the incidents for business reasons (Harlan, 1995).

Profiles of Those Who Commit Workplace Violence

Providing a profile of the "typical" violent employee is difficult for a number of reasons. While the information is helpful, it could unintentionally stereotype employers against certain applicants or current employees. Matching the profile in no way guarantees that a person will commit an act of workplace violence. However, repeated similarities in comparison to the profile should raise flags and alert supervisors to potential behaviors, which, if committed, warrant disciplinary review. Additionally, numerous violent acts are committed by individuals who in no way resemble the profile. Thus, one must use caution in interpreting and applying this information, and remember it in terms of generalities rather than specific characteristics of an individual.

Perpetrators of workplace homicides in 1996 included six percent who were either acquaintances or relatives of the worker, 14 percent who were work associates, and the final 80 percent who were committing crimes (i.e., robbery) (US Department of Labor, 1996). In 1993, current or former co-workers were responsible for 5 (male victims) to 9 percent (female victims) of the homicides, while they perpetrated 5 (female victims) to 14 percent (male victims) of the nonfatal injuries (Harlan, 1995).

Generally, those employees who perpetrate workplace violence are Caucasian males. They tend to be in their mid-30s to mid-40s, have limited social support, externalize their problems (often through blame), are preoccupied with weapons and/or violence, and identify strongly with work (Baron, 1993; Bensimon, 1994; McGarvey, 1994). Additionally, others often describe perpetrators of workplace violence as "loners" with dysfunctional relationships or ones limited to being acquaintances.

Johnson and Indvik (1994) suggest that those who have been emotionally or physically abused as children bring that trauma to work and during extreme stress may act out in ways they learned as children. Those who perpetrate violence often provide some warning in the form of verbal threats, have histories of intimidating others, may exhibit decreased work performance, have erratic attendance, and exhibit symptoms of paranoia or depression (Baron, 1993). The paranoia may focus on a specific co-worker or supervisor, or manifest in a more generalized manner, such as difficulty accepting feedback, being hypervigilent, and making numerous accusatory statements to others. Perpetrators often have other life events occurring that increase their stress levels at work. For instance, if a significant relationship is breaking up, they might turn to work to fulfill the self-esteem gap they are experiencing. If something then goes wrong at work, it may be the last item in a series of triggers.

Preventive Actions 

Workplace violence generally can and should be addressed at three points: pre-employment, disciplinary policy, and post-incident (Keyes & Keim, 1996). When consulting with companies regarding work environment and employee work adjustment, rehabilitation counselors optimally would include suggestions regarding workplace violence and proactively address the issue before it occurs. For example, specific zero-tolerance disciplinary procedures can be developed and followed. A zero-tolerance policy might state that any verbal threat of violence directed toward another employee will result in the employee who made the threat being terminated without exception. Any employee who physically attacks another employee regardless of the seriousness of the attack will be fired.

When such policies are sporadically enforced or ignored by the company, employees may feel there will be no consequences to breaking the rules. Each employee should receive a copy of the policy and sign one (which is retained by human resources) stating that they understand and agree to abide by the policies. Additionally, rehabilitation counselors placing individuals in work settings should be prepared to answer possible questions regarding potential for violence.

One of the key areas companies should be advised to review are security procedures. Keeping track of current versus former employees, establishing visitor access, and noting employee rosters are critical (Keyes and Keim, 1996). Within the building, each site should be examined for violence potential, paying particular attention to dark or remote areas, as well as those in which hostages could easily be taken and held. As with fire evacuation plans, plans for evacuation in case of terrorist threats/acts such as bombings should be planned and practiced. Within healthcare settings, medical and rehabilitation facility personnel should be aware of and trained to recognize violence from patients and learn ways to address these situations.

Companies need a plan to address workplace violence prior to its occurrence. Rehabilitation counselors could assist companies in forming crisis response teams and make recommendations regarding the plan. This outside viewpoint provides essential insight that those within the company may miss due to close proximity. The crisis response team should include representatives from security, human resources (HR), management, public relations, and medical/psychological services (if present within the company). Outside authorities and emergency responders are contacted as the situation warrants.

A developed crisis response plan should be written and displayed at numerous locations throughout the business. Critical tasks should be clearly stated and outlined in steps. Some areas toinclude are: key response personnel, where to direct uninvolved employees, and who has authority to speak to the press. Additionally, companies must decide how employees will be informed of the situation, released from work, and whether other shifts should report to work. Elliott and Jarrett suggest organizing a telephone tree to contact employees (1994).

Incident Response

Following the resolution of the incident and completion of any preliminary police and security actions, those involved should be offered psychological support. The human resources department generally would be the department seeking psychological assistance for the survivors and others who witnessed or were impacted by the event. When rehabilitation counselors and human resource departments have close relationships from previous rehabilitation cases, the HR director may call on rehabilitation counselors for assistance. This role can take a number of forms. Rehabilitation counselors can work with the perpetrator, if not incarcerated, injured, or deceased, to determine the nature of the problem and attempt to resolve it in a psychologically healthy manner. Assistance with outplacement counseling is another service that might be provided.

Victims of the incident may have long-term physical injuries which will require rehabilitation. For example, a security person who is injured while providing protection may require rehabilitation. Rehabilitation counselors work with injured individuals to assist them in returning to work or preparing for different careers. Immediately following the incident, rehabilitation counselors should assess whether employees are in need of immediate care, their overall psychological condition, whether they are well enough to go home, and if they are capable of getting themselves there. Some may be too traumatized and transportation must be provided for them. Finally, those who witnessed the event or were impacted by the event should be offered some type of psychological assistance.

Often counseling following workplace violence is offered in the form of a debriefing. Mitchell (1983, 1988) developed a model for debriefing emergency responders which has been widely adapted and extended to applications with disaster, crime, and other survivors of trauma. Debriefing generally consists of five phases. Initially the debriefing is introduced with expectations, informed consent, voluntary participation, and introductions. Participants then are asked to disclose what happened, what they thought, saw, and heard, as well as their role in the incident. As the debriefing continues, the level of disclosure increases as participants discuss what feelings and reactions they have experienced in relation to the event. Next, the counselors explore the signs of stress participants are experiencing and how they are coping with their stress, Counselors utilize this opportunity to suggest various effective coping strategies and normalize the participants' experiences. The final step consists of closure. Counselors help participants with closure, provide a summary, and give referrals for additional counseling when appropriate. Debriefing, following the incident, would have been helpful to the rehabilitation counselor mentioned in the introduction of this article. However, as a result of later intervention with the expert and subsequent referral for brief counseling, the worker successfully continues to work for the company.

Projections of increased workplace violence in the 21st century appear warranted given trends of recent years. Companies will seek assistance in addressing the problems which arise as a result. Both those who commit the acts and those who are victims will need assistance. Additionally, companies will need assistance in determining workplace violence costs, in particular when litigation is involved. Rehabilitation counselors are in a unique place to fill this role. They are currently actively involved with companies, are able to assess costs involved in the work force and have the skills necessary for consultation and counseling intervention.

References

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Jeanmarie Keim, Ph.D., CEPR, 100 Ball Ed, The University of Memphis, Memphis, TN 38152-6010. Email: [e-mail]