Case Study - “Psychological Problem”

Author :Channagiri

The Incident

A Division administrator contacted Human Resources because of a female employee who was displaying memory lapses, sudden physical disability, disorientation, agitation, inability to focus and retain information, sudden arrival at coworkers’ residences in a troubled state, threats to harm herself, and possession of a knife and a handgun while off-duty at the homes and in the presence of a coworker. The employee had been an unexpected overnight guest when she appeared at colleagues’ homes in a troubled state. She has been disoriented to her surroundings, and unable to identify those with whom she regularly works. Colleagues have transported her to hospital emergency rooms, and to scheduled medical and mental health treatments. Coworkers are distressed about the potential threat posed to them by the employee.

Incident Response

The Human Resources Division contacted the Employee Assistance Program (EAP) for initial consultation. The EAP recommended bringing in a psychologist with threat assessment expertise to meet and help devise a response plan.

The initial meeting consisted of several representatives of Human Resources, the Division administrator, the EAP and the threat assessment psychologist. At this meeting, the background of the case and the employee was discussed. The employer revealed that the goal of the intervention was to devise a strategy which would enable the safe retention of the employee.

Administrator

The Division administrator was tasked with providing the personnel file to the psychologist for review. He would also arrange for the employee to be evaluated by the psychologist for purposes of providing a plan of action based upon a mental health, or Fitness for Duty evaluation. He arranged for coworkers to have access to the EAP program in order to address their fears and consequent mental health needs.

Human Resources

The Human Resources administrator contacted security in order to develop background information related to the employee. Information about the employee’s criminal history of violence and weapons possession was desired. The Human Resources administrator also consulted with the Division administrator to make sure that the organization’s policies and procedures were implemented. The Human Resources office articulated questions that they wanted answered by the Fitness for Duty evaluation.

Employee Assistance Program

Timed to coincide with when the Fitness for Duty evaluation was being conducted, the EAP had a crisis debriefing session with all employees. The purpose of this debriefing was to address ongoing concerns of the employees, provide information that may lead to their reassurance that the organization was acting responsibly, and to provide linkage to individual counseling. The EAP also conducted individual short-term counseling and referrals for employees who expressed a need for these services. In a manner ensuring confidentiality, the EAP provided information to the threat assessment psychologist about behaviors of concern to these employees.

Threat Assessment Psychologist

The psychologist interviewed selected administrative staff and learned the employer’s goal was the safe retention of the employee. Information was developed that the employee had no criminal history. Initial information was that the employee had recently been evaluated for a stroke, but that the physical complaints of this employee had no known medical causation. A referral had then been made for psychological care.

The threat assessment psychologist met with the employee and gained access to her mental health files. It was learned that she became depressed and anxious, and started to have flashbacks and disconnected memories of her childhood. She had trance-like dissociative states. She was suspected of being a victim of sexual abuse as a child, as well as some other violence. Her psychiatrist prescribed a number of medications commonly used in treating depressive, panic, seizure and psychotic disorders.

Psychological testing was conducted, with results indicating the employee was not in touch with her emotions, that may overcontrol the way that she expressed her anger. Her profile indicated that she tended to be impulsive and act out in socially unacceptable ways. She showed a pattern of guilt and remorse and negative self-evaluation after her impulsive behavior, but she tended to repeat this behavior. People with her profile tend to feel tense, agitated and unable to manage their problems. They engage in compulsive behavior and set high standards for themselves and feel guilty when such standards are not met. The test results showed that she had superior intellectual functioning. While she has admitted to recent suicidal ideation, her test results did not suggest a tendency to express anger outwardly. Her pattern of test results suggests that she may have symptoms of a number of psychological conditions.

The psychologist interviewed the employee. She admitted hearing voices. She described these voices as coming from within her head and that the identity of the voice was known to be her. At times, the voices argue. She showed no evidence of obvious delusional beliefs. At times, her memory and concentration appeared lacking for someone of her intellectual capacity. She said that she did not understand why her employer was involved in her situation. She expressed apprehension that she may lose her job.

The employee expressed distress over her recent behavioral changes. She claimed that she finds herself at different locations without remembering the circumstances of her travel.

The employee denied any homicidal ideation, thoughts, intent or plans. She admitted to suicidal ideation in the past, the last time 2-3 months ago. Her plan had involved shooting herself and at least on one occasion, she had placed a gun to her head. She had thoughts about driving her car over a cliff, but she did not pursue this because the outcome was “not guaranteed.”

She told the psychologist that a few months ago that she had attempted to acquire a handgun for target practice because she could not bring an unregistered weapon — which she possessed — to the range. She was unable to acquire one because she truthfully answered registration questions pertaining to her mental condition. She had, and may continue to have, access to two other weapons. She claimed that her husband’s unregistered handgun was dismantled. She said that a second unregistered weapon had been in a safe deposit box, but that she then anonymously had mailed it to the police. When the psychologist expressed skepticism that she had mailed this weapon to the police, she then denied mailing it and claimed that she had thrown the gun into the ocean after contemplating killing herself. The employee revealed that she is an experienced shooter of weapons, having been trained to shoot by her father when she was aged four or five. She said that she knows that she can always go to a shooting range to use a weapon there.

The employee disclosed that she had increased her level of alcohol consumption over the past six months. She admitted that she had consumed one and a half beers before coming into the psychological interview in an attempt to manage her anxieties. While she denied any history of problems with alcohol or craving to drink, she revealed that a friend of hers had told her that her drinking was making matters worse. She denied any current abuse of illegal substances, but admitted smoking marijuana and using Ecstasy on several occasions while in college.

An interview with the employee’s supervisor indicated that over the past few weeks, she had been doing well in her work. He felt that she was getting better. He was able to tolerate her occasionally taking sick leave because of episodes that she may experience. He considered her one of the best employees he ever had. 

The psychologist completed his evaluation and wrote a detailed report on his findings. 

Resolution

The Fitness for Duty documented the severity and variety of her psychological conditions, that the conditions would become noticeable on a periodic basis, and that this would prevent her from working during that time period. During acute episodes of her disorder, she was viewed as being unable to perform some or all of her work functions, duties and responsibilities. 

During the period of time that her condition flared, she was considered to be a mild-substantial danger to hurt herself. The level of risk varied as a function of her fluctuating psychological course. Also elevating the risk level was the potential presence of handguns, the location and security of which were not adequately documented. While the employee denied any thoughts, intent or plan to hurt others, the presence of weapons was perceived to elevate the risk that others could be inadvertently hurt in any attempt to hurt herself. Additionally, others who might seek to disarm her could be injured in this process.

The report concluded that if the employer wanted to keep the employee working under these conditions, that coworkers should not transport her for medical care, but should call an ambulance and security if such care was needed. It was also recommended that the employee be directed to have her weapons secured by police authorities. The Employee Assistance Program was suggested as a resource that could be tasked with making recommendations regarding the employee gaining access to specialized treatment programs on the mainland, which programs could be helpful to the employee.

The employer was advised that a comprehensive risk management approach would also involve retaining a security firm that could develop additional information about the behavior, thinking and plans of the employee. The security firm could engage in surveillance or pretext contacts in order to aid in managing the case. The employer was informed that this approach could serve as an early warning system if the employee were engaged in active measures to plan an act of violence. Despite this recommendation, the employer decided against these measures.

The employer decided to retain the employee and to continue to provide accommodation. The employer provided time off for psychological care and discontinued the practice of employees providing transportation to psychological and medical care. The employee has been performing her duties well. Another employee decided to quit because she was so traumatized about being exposed to the behavior of her coworker.

Questions for Discussion

Practice Exercises


“The Suspicious Caller”

You are a health care worker at the agency’s clinic in Wotakki. As you are filling out your patient charts one evening, you hear the phone ring at the nurse’s station and pick it up. The caller’s voice is muffled, as if he had a handkerchief over the receiver. You also think you hear traffic in the background so it makes it even harder to hear. He starts talking very quickly and says, “I DON’T LIKE WHAT YOU ARE DOING AT THAT CLINIC AND I WANT IT TO STOP. I HAVE A BOMB PLANTED IN THE BUILDING AND PLAN TO SET IT OFF VERY SOON. YOU WILL BE SORRY NOW FOR WHAT YOU DID!” He hangs up the phone.

THINGS TO THINK ABOUT:

  1. What would you do now?
  2. Based on this conversation, what information would you provide to law enforcement personnel? 

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