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International Journal of Forensic Mental Health
ISSN: 1499-9013 (Print) 1932-9903 (Online) Journal homepage: http://www.tandfonline.com/loi/ufmh20
Staff Experience of Harassment and Stalking
Behavior by Patients
Martin Clarke, Ian Yanson, Younus Saleem, Rachel Edworthy & Najat Khalifa
To cite this article: Martin Clarke, Ian Yanson, Younus Saleem, Rachel Edworthy & Najat Khalifa
(2016) Staff Experience of Harassment and Stalking Behavior by Patients, International Journal of
Forensic Mental Health, 15:3, 247-255, DOI: 10.1080/14999013.2016.1166465
To link to this article: http://dx.doi.org/10.1080/14999013.2016.1166465
Published online: 26 Apr 2016.
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Staff Experience of Harassment and Stalking Behavior by Patients
Martin Clarke
a
, Ian Yanson
b
, Younus Saleem
c
, Rachel Edworthy
d
, and Najat Khalifa
a
,
c
a
Nottinghamshire Healthcare NHS Foundation Trust, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United
Kingdom;
b
Nottinghamshire Healthcare NHS Foundation Trust, Rampton Hospital, Woodbeck, United Kingdom;
c
Nottinghamshire Healthcare
NHS Foundation Trust, Wells Road Centre, Nottingham, United Kingdom;
d
Division of Psychiatry and Applied Psychology, University of
Nottingham, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
ABSTRACT
Staff from one National Health Service (NHS) Trust in England completed an online survey (ND590)
about their experience of intrusive behaviors from patients. These experiences were categorized
into either stalking or harassment and compared in terms of staff and patient characteristics, types
of intrusions, and aftermath. Overall, 150 were classified as being stalked (25.4%) and 172 harassed
(29.2%). There were no differences in staff characteristics between the two groups. Staff from
forensic services and nursing staff were particularly susceptible to these intrusions which took many
forms. Respondents perceived a range of causes for the stalking and harassment, the most common
being to gain power and control/to scare. It was rare for legal sanctions to be brought against the
patient. Our findings reinforce the need for service providers to have policies supported with
preventative measures, education and a robust process for addressing stalking so that these
measures are embedded in practice in a way that supports staff working with patients. Furthermore,
service providers should be challenged on what steps they have taken to prevent, and monitor,
such behavior.
KEYWORDS
Stalking; harassment;
intrusions; staff; patients
In England and Wales, prevalence rates for stalking
among adults aged 16 to 59 years indicate that approxi-
mately one in five women and one in ten men have been
stalked at some point in their lives (Chaplin, Flatley, &
Smith, 2011). Stalking can have a negative impact on the
victim’s quality of life with undesirable psychological,
social, and occupational consequences (Path
e & Mullen,
1997,2002; Purcell, Path
e & Mullen, 2004; Mullen, Path
e
& Purcell, 2009).
Societal and professional interests in the management
of stalking behavior have grown significantly over the
past decade or so. For instance, in 2010 the National
Stalking Helpline (http://www.stalkinghelpline.org) was
launched in the UK to provide guidance and support for
victims of stalking, and in 2011 the National Stalking
Clinic (www.beh-mht.nhs.uk/nsc) was launched in Lon-
don to provide specialist assessment and consultation for
those who have engaged in stalking behaviors. However,
since its introduction into everyday lexicon in late 1980s,
defining the term stalking has been fraught with difficul-
ties, not least because many of the behaviors associated
with stalking overlap with people’s everyday experiences
such as receiving unwanted communications or being
approached for a date (Purcell et al., 2004).
The legal definition of stalking has changed consider-
ably over the years. For instance, up until 2012, people
accused of stalking behavior in England and Wales were
prosecuted under harassment laws, such as the Protec-
tion from Harassment Act 1997, but the threshold was
such that a charge could only be brought when these acts
were deemed to cause a fear of violence. The Protection
of Freedoms Act 2012 reduced such threshold by incor-
porating two specific offenses of stalking into the Protec-
tion from Harassment Act 1997, namely ‘stalking’and
‘stalking involving fear of violence or serious alarm or
distress.’Subsequently, the number of stalking and
harassment prosecutions rose by more than 20% in 2014
and a further 15% in 2015 (Crown Prosecution Service,
2014,2015).
Behavioral scientists regard stalking as a constellation
of behaviors in which a person makes repeated and per-
sistent unwanted intrusions that cause the recipient to
experience distress and fear for their safety (Mullen,
Path
e, Purcell, and Stuart, 1999; Purcell et al., 2004).
Path
e and Meloy (2013)defined stalking as:
The repeated infliction on another of unwanted commu-
nications (e.g., through letters, telephone calls, email,
CONTACT Martin Clarke [email protected] Room B07, Institute of Mental Health, University of Nottingham Innovation Park, Triumph
Road Nottingham NG7 2TU, UK.
© 2016 International Association of Forensic Mental Health Services
INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH
2016, VOL. 15, NO. 3, 247–255
http://dx.doi.org/10.1080/14999013.2016.1166465
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and social networking websites), unwanted contacts
(e.g., following and approaching), and a myriad of other
harassing behaviors (e.g., malicious complaints, threats,
and assaults), in a manner that causes reasonable fear
and distress. (p. 200)
Using data from an epidemiological survey in the
Australian community, Purcell et al. (2004) sought to
distinguish the point at which unwanted intrusions
become persistent stalking based on the number of
harassment methods experienced and the victim’s life-
style alterations. They defined stalking as experiencing at
least two harassing intrusions which had caused fear.
Purcell et al. (2004) analyzed these data at 1-week, 2-
week and 4-week cut-offs and found that 2 weeks was
the ‘critical threshold’which allowed them to discrimi-
nate between two types of intrusiveness—briefer inci-
dents of harassment and protracted stalking—with
different impacts on victim’s functioning (Purcell et al.,
2004). The authors argued that this distinction was
important to enable early intervention to assist the vic-
tims. Studies often use a 2-week cut-off (Jones & Sheri-
dan, 2009; Purcell, Powell & Mullen, 2005; Whyte,
Penny, Christopherson, Reiss, & Petch, 2011) although
some, for example, Galeazzi, Elkins, and Curci (2005)
have used a 4-week cut-off. The number of incidents
required to constitute stalking has also varied with some
studies using at least two (Purcell et al., 2004), 10 (Whyte
et al., 2011), or more than 10 incidents (Galeazzi et al.,
2005).
Stalking and harassment of mental health
professionals
Existing literature suggests that mental health professio-
nals, such as psychologists (Gentile, Asamen, Harmel,l &
Weathers, 2002; Purcell et al., 2005), psychiatrists
(Whyte et al., 2011; McIvor, Potter, & Davies, 2008;
Nwachukwu, Agyapong, Quinlivan, Tobin, & Malone,
2012) and nurses (Ashmore, Jones, Jackson, & Smoyak,
2006), are particularly at high risk of being victims of
stalking (for a comprehensive summary, see also Path
e&
Meloy, 2013). The true prevalence rates for stalking of
mental health professionals by patients are not easy to
obtain given that survey response rates vary from
approximately one-quarter (Whyte et al., 2011) to three-
quarters (Galeazzi et al., 2005). Nevertheless, existing lit-
erature suggests that between 20% (McIvor et al., 2008;
Purcell et al., 2005) and 40% (Jones & Sheridan, 2009)of
mental health professionals have been stalked by
patients. This is thought to be related to the observation
that mental health professionals are more likely to be in
contact with people who are lonely, isolated, and have
disordered attachment patterns (Galeazzi et al., 2005).
Stalking and harassment towards staff within mental
healthcare settings are under-recognized despite the high
risk of occurrence, the distress caused and the impact these
behaviors have on the victims (McIvor & Petch, 2006). For
instance, victims of stalking often make changes to their
professional and personal functioning such as increasing
security at work or home and changing telephone numbers
(Purcell et al., 2005). However, there is a risk that professio-
nals minimize stalking in therapeutic contexts and that
such incidents are underreported (Path
e&Meloy,2013).
The evidence reviewed above suggests that mental
health professionals are particularly vulnerable to the
unwanted intrusions of their patients. While many
authors called for increased awareness among mental
health professionals and more training around stalking
(McIvor & Petch, 2006), few made concrete recommen-
dations in relation to how knowledge in the field could
be advanced further. More specifically, what is less clear
is whether the types of intrusions, antecedents, and after-
math are different for staff who have been stalked or
those who have experienced lesser forms of harassment.
In accordance with the conclusions reached by Purcell
and colleagues (2004), we argue that this is an important
issue to consider. Identification of staff who have been at
the receiving end of stalking is crucial to facilitating effec-
tive intervention to prevent undesirable consequences for
the victim. It is equally important that healthcare pro-
viders are able to recognize staff’s experiences and tailor
interventions as appropriate to contain the situation.
The current study
We surveyed staff with patient contact at one National
Health Service (NHS) Trust to examine intrusions, cate-
gorized into either stalking or harassment, from patients.
We then compared the experiences of those who had
been stalked with those who had been harassed. We
sought to answer the following research questions: Are
there any differences between the experiences of staff
who have been subject to stalking by a patient and the
experiences of staff who have been subject to harassment
by a patient by patients in relation to: (1) staff and
patient characteristics; (2) types of behaviors experi-
enced; (3) perceived cause; (4) organizational response
to the harassment or stalking; (5) reason for cessation of
harassment or stalking?
Method
Setting and participants
Participants were staff with patient contact working in a
large NHS Trust in England which employs approximately
248 M. CLARKE ET AL.
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