Initial assessment and intervention strategies to reduce workplace violence.

Homicide is now the cause of 12 percent of deaths in the workplace, and workplace violence by disgruntled employees or former employees continues to increase. The family physician may be the first or only professional to examine such persons before an act of violence occurs. The assessment of a potentially violent employee includes evaluating for threats, a history of violence, paramilitary interests, access to weapons, paranoia, substance abuse and a sense of having no future or no alternative to violence. A shame-rage cycle that may include a sense of evernarrowing options often precedes the violent act and may reveal warning signs that represent potential opportunities for intervention before the act is committed. Initial interventions include ensuring the immediate safety of potential victims, initiating measures to reduce acute shame and rage in the person at risk and facilitating an effective referral. Preventive strategies at the organizational level include preemployment screening, explicit nonharassment policies, employee counseling, physical security measures and the establishment of an organizational clearinghouse for reporting and assessing threatening behaviors.