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A major Mental Health Trust in the UK has around 2000 staff including doctors, nurses, psychologists and other health professionals, arounf a half of which work within the community or make home visits. Most of these can be lone workers, including doctors who provide general care and make assessments under the Mental Health Act; community psychiatric nurses who provide help and support; outreach staff who help people who find it difficult to use the Trust's services; and home treatment staff. The Trust provides mental health care, and its facilities range from inpatient wards to community mental health centres. It also provides many other services such as forensic services and help with eating disorders. These lone workers face a variety of risks in their day to day work, including: * Staff need to attend inner city regions where the chances of experiencing violence are greater. * Staff often have to visit clients in tower blocks or other similar buildings. Sometimes lifts are poorly lit and there are concealed spaces. Also, the public have access to buildings where staff may be working late at night. * Many violent incidents occur in the evening and at staff changeover times. Doctors may have to visit peoples' homes late at night and sometimes require police support if there is increased risk. * Doctors, community psychiatric nurses and community nurses might be believed to be carrying drugs and may therefore be targets for assault. * Most of the people who have some kind of mental illness are not violent but unfortunately a few do sometimes act violently as a result of their mental illness. * Withholding treatment can put both staff and members of the public at risk of violence and abuse. Examples of incidents that staff have experienced include: * Physical assaults. * Threats of physical violence, including the use of weapons. Staff have also seen weapons or drug-related items in the homes of some clients. * Intimidating behaviour * Staff being shut in a room and not allowed to leave. To address these risks the Trust is working to ensure that their people are in constant communication throughout their working day. Across the board, all community staff are issued with mobile phones. Moreover, along with other trusts, they are also evaluating the use of mobile phones with GPS satellite positioning capability. Satellite positioning locates staff at the exact address after they trigger an emergency alarm. The first response if provided by the ambulance service. The alarm opens a communication channel which is also recorded. Workers can decide what they want their emergency response to be. Based on experience to date, the Trust feels that this is an important safety mechanism for certain staff groups. For staff whose role is likely to have less risk to their safety, then an alternative mobile phone system has also been considered. This makes it necessary for staff to text their location to a centre before making a visit. Although this is less expensive than the satellite positioning mobile phone system, the Trust has concluded that this approach does not enable an immediate response or identification of the exact position of the member of staff at the time of an incident, so is only favoured for staff at the very low end of the risk spectrum.
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