Fighting Fear

Confronting phobias and other fears

Disarming a Man Wielding a Knife

On a psychiatric ward

This is a trick that works every time. Imagine a patient on a psychiatric ward who has managed to obtain a knife and is menacing everyone with it. I have no trouble imagining this scene since I have found myself, on a couple of occasions, in the middle of it. These situations do not come up often, but it is good to have a plan in case they do. Someone waving and poking a knife around is dangerous.

In general, psychiatric wards are not safe places; and they should be avoided if possible. Being admitted to a locked psychiatric ward often puts patients in a bad mood, and someone who is otherwise inclined to behave himself/herself feels entitled to act under those circumstances as if he/she is out of control. A strait-jacket or restraints used to be employed in that situation, but patients would invariably get more annoyed by being tied up. Then they would have to be locked into a seclusion room. The seclusion room is the fabled “padded cell” one hears about, although I have never seen one that actually had padded walls. Nowadays, an overly obstreperous patient is more likely to be held down and injected with tranquilizers. The drugs are similar to those used in the zoo on tigers and lions who need dental work or other medical procedures.

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Even less troubled patients are inclined to act up on a psychiatric ward. They may think it is expected of them. I had a patient once, a lawyer, who ran up and down the ward screaming that he did not belong there. I pointed out to him that he was the only one running up and down the ward screaming. 

It is not only knives. I once had a patient who was always throwing cutlery at me—spoons, forks, anything at hand—even though I asked her not to. Another time, another patient who was throwing a chair at a nurse almost hit me. I was always uneasy if a policeman was standing around with a gun since it happens every once in a while that a patient will wrestle the gun away and point it in the direction of the psychiatrist, even though the psychiatrist could be reasonably described as an innocent bystander. It is beholden on the psychiatrist, then, to convince the patient of that fact. And not every psychiatrist has proven up to the occasion. It is important to be prepared for these situations, which come up infrequently, but are upsetting and sometimes fatal.

So, this is what you do to disarm a knife-wielding patient: First, you get as many staff around as possible, including male nurses—big male nurses—if they are available. If the patient sees that he is greatly outnumbered, he is less likely to try to stab someone and run away. Then you grab three or four mattresses and hold them out in front of you (one per person.) You then move in unison up to the patient, pinning him against the wall. If he stabs down, the only thing he can hit is the mattress. Then, while he is coping with all these mattresses coming at him, the patient is tripped up by another staff member who sneaks under the mattresses and pulls the patient’s feet out from under him. Then everyone sits on him, mattress first. Then they wrestle the knife away.  It works every time.

If someday you are challenged by someone in a dark alleyway who comes at you with a knife, it is better to run away unless you are part of a large group and there are a number of mattresses lying around.  (c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog/ or ask advice at fredricneumanmd.com/blog/ask-dr-neuman-advice-column/

 

 

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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