We describe the success of one general hospital in reducing violent behavior among a group of repetitively disruptive patients. Following a pilot phase during which violent incidents at the medical center were characterized by location, type, and person responsible, a group of patients at high risk for repeated violence was identified (N = 48). Data were gathered for 1 year before and after the institution of a program designed to reduce violence, primarily in ambulatory care areas, among this group. Outcome assessment included comparison of the number of violent incidents and the number of visits to the medical center during the 12 months before and after the program was started. The number of incidents declined by 91.6%, and visits to the medical center for any reason decreased by 42.2%. The ratio of violent incidents to visits after the program was begun was less than one sixth the rate before the program. Components of the program are described, including staff resistance and management strategies.
Stalking is a prevalent issue that is often underreported and underdiscussed both in the general population and in clinical settings. Among mental health professionals, 6%-11% of providers will be stalked by a patient during their career. Stalking has a considerable negative impact on both the personal and professional lives of these individuals that is compounded by systemic and individual factors. Many health care organizations lack well-defined procedures on how to manage stalking, and mental health professionals have been found to have minimal training in how to address stalking behavior. Ethical guidelines across multiple health care disciplines emphasize avoiding harm and maintaining patient confidentiality. Although state licensing boards allow exceptions to confidentiality as mandated or permitted by law, these state laws may offer little protection to the mental health professional being stalked by his or her patient. Failing to address stalking behaviors could be detrimental to both current and future providers as well as preventing the stalker from receiving modification of problematic behavior. General models of stalking management have been offered in the past, but few address the specific challenges associated with the stalking of mental health professionals by their patients. The authors present 2 vignettes to demonstrate the common management challenges of these cases. The authors propose a dual pathway, 3-tiered model of stalking management that adopts a public health approach to guide interventions both on the individual provider and systemic level. Limitations and suggestions for future research are discussed.
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