Being Stalked--An Occupational Hazard?

Education and strategies

Because awareness of stalking is limited, according to McIvor and Petch,¹ health care organizations should consider adopting formal educational programs, particularly for staff in the early stages of their career.

Such programs would center on increasing awareness of the problem, highlighting increased risk for mental health professions, and summarizing the current literature on the subject, McIvor told Psychiatric Times. This could be followed by general ways to reduce the risk of being stalked and advice on what to do if it actually begins.

McIvor emphasized that it is vital to take any stalking behavior seriously from the beginning.

"After receiving the first letter or contact, tell the patient clearly and unambiguously that their behavior is unacceptable and should stop. This will often be enough. If it continues, inform colleagues and have no further contact with the patient, ensuring that their care is transferred appropriately," he said. "Do not initiate further contact with the patient; it will simply reinforce the stalking behavior. Get the police involved sooner rather than later, [because] a verbal warning may be enough to stop further harassment."

McIvor, Binder, and Meloy each offered some strategies to reduce the risk of being harassed or stalked by a patient or ex-patient and to address such behaviors. A compilation of their suggested strategies includes the following:

• When working with a new patient, set limits early. Define what a therapeutic relationship is and what boundaries are.
• Minimize risk by using a work or post office address rather than home address in directories of professional or community organizations; by removing yourself from online search engines; by using pseudonyms when expressing opinions via the Internet in bulletin boards and online discussions; by shredding personal and domestic documents; and by not disclosing personal information to patients or having family pictures in the office.
• Carry out a risk assessment (risk factors, history, etc).
• If you are the target of criminal behavior of a current patient, attempt to terminate the case in a professional way, such as by making appropriate referrals. Don't be overly concerned about treatment abandonment issues.
• Pay close attention to how your behavior could unwittingly reinforce the stalker's pursuit.
• Let colleagues know you are being harassed and/or stalked and alert others in the building in which you work.
• Carefully document all incidents, including transcribing messages left on your phone rather than just erasing them.
• Retain any evidence (eg, letters with envelopes: DNA samples can be extracted from the back of a postage stamp).
• Get advice from experts in stalking behaviors. This is particularly helpful should the patient file a complaint with a state licensing board, alleging treatment abandonment or some other misconduct.
• Contact police, but recognize that this does raise issues of confidentiality. An initial contact might be: "I think I am being stalked but I'm not free to identify who it is. I want to at least report this incident and talk with somebody in my jurisdiction about this threat toward me."
• Seek help for the psychological consequences, including feelings of fear, anxiety, guilt, helplessness, anger, frustration, and disenchantment with the profession.