Behaviour of concern – MAT Health Clinic

A behaviour of concern refers to any behaviour that causes physical harm to the person or another person, or destroying property resulting in the risk of harm to the person or any other person.

it is important to understand that people do not always act or respond to situations in a predictable manner. Patients become challenging, difficult, uncooperative or aggressive for a number of reasons. Here are some examples:

• Being unwell or in pain
• Being emotional from personal situations such as the death of a loved one
• They may be worried, anxious or scared about seeing the doctor
• They may have communication or language difficulties
• They may be frustrated
• They may have had a previous poor experience
• They may have unrealistic expectations of our services
• They may be affected by alcohol or drugs
• They may be disabled or have a mental illness

Is it the patient?
Always consider first whether the patient’s behaviour is caused by a medical condition. Some medical conditions can cause agitation such as: anxiety or mood disorders, depression.
Does the patient suffer from Alzheimer’s or dementia?
Is the patient affected by drugs or alcohol?
Does the patient have a mental health condition that can cause irrational behaviour, confusion, disorientation, delusions?

Is it a lack of resources?
Long waiting times, lack of available appointments, poor communication by staff, etc. may all contribute to a patient’s deteriorating mood or behaviour.

Aggressive behaviour:

• threatening or intimidating behaviour
• being demanding or controlling
• an unwillingness to listen/lack of cooperation
• physical violence against people or property.

Verbal Offensiveness:

• Swearing
• Yelling
• Harassment – (Bullying, racism, stalking)
• Verbal Abuse or threats

Intoxication:

A state in which a person has consumed enough alcohol or drugs that their mood and physical and mental abilities are noticeably affected

Unfortunately, there is no one answer. Each patient and situation are different and will need to be dealt with in different ways.

Dealing with difficult patients will always be a challenge. How you handle the situation can make all the difference! Your ability to defuse tense situations and confidently manage patient aggression will ensure you, other patients and your work colleagues are safe.

Thinking about the reasons why people may be showing behaviours of concern will assist you in remaining calm and thinking through some strategies which may assist you with managing the behaviour effectively. Whilst managing these behaviours is part of the job, it is not acceptable for workers to be hurt.

Taking care not to put themselves or others at risk, the employee should:

• Pause – stand back, take a moment before approaching and assess the situation
• Approach the person with respect and empathy
• Try to manage your own emotions – don’t take it personally
• Anticipate any potential triggers for conflict
• Monitor your non-verbal and verbal communication style
• Manage the environment

De-escalation

Prompt response may stop a behaviour continuing or escalating. 

• Be aware of body language and tone of voice used to the person
• Try not to rush the person, act calmly
• Listen to the person’s concerns, let them vent, do not talk over them
• Validate the patient’s statements and feelings, be empathetic. The staff member does not need to agree with what is being said but they can acknowledge that they understand what the patient is feeling

The following principles will assist you in managing the situation effectively:

Monitor your verbal communication

• Keep the conversation centred on the person’s needs
• Reassure them and acknowledge their grievances
• Have a concerned and interested tone of voice
• Ask open questions to build discussion
• Do not shout or raise your voice
• Do not give threats, orders or advice
  Avoid ‘If I were you…’ or ‘You’d better stop that right now or…’
• Avoid personal remarks, harsh aggressive or abrupt statements.  Don’t say things such as “You must….”, “Don’t…..”, “Stop…….”.  Use alternatives and “I’ language like “I would like you to…” It would help me if……”, “I feel scared when…….”.
• Do not argue the point. You don’t need to defend or justify yourself

Monitor your non-verbal communication

• Do not attempt to touch the person (unless in self-defence)
• Allow time for open communication. Don’t rush
• Move slowly and gently
• Use culturally appropriate eye contact
• Relax your body
• Do not place hands on hips or in pockets, finger wag or prod, cross arms or clench fists
• Give at least two arms’ length of personal space

Managing the environment:

• Remove bystanders and unnecessary staff from the view of the person (if possible)
• Ensure the person’s privacy
• Keep exits clear and accessible
• Remove potentially dangerous items
• Maintain a safe distance, back off where possible and plan an escape route

Seek Assistance

If the person continues with the behaviour of concern and the employee feels distressed and/or in danger the employee should:

• Call for help and alert other staff members for assistance
• Leave the person to calm down, if possible
• Call security, policy or activate the duress alarm

An intoxicated person may harm themselves or others. Their behaviour can also be very annoying or frightening for people nearby. You need to handle these situations carefully because an intoxicated person’s behaviour can be very unpredictable. You should:

• approach them slowly and try to maintain eye contact
• observe the situation and see whether you need someone else’s assistance
• try to get the individual to a quiet space, but avoid touching them or getting too close
• speak calmly and let them know what you want them to do
• use an alarm if the situation looks as if it is getting out of control or the person becomes aggressive

Defusing (immediate small group support) is conducted by a trained staff member and is designed to bring the experience of the incident to a conclusion and provide immediate personal support. The aim is to stabilise the responses of workers involved in the incident and provide an opportunity for them to express any immediate concerns. This step should take place within 12 hours of the incident.

Strategies include:

• Review the event.
• Clarify workers’ questions and concerns.
• Encourage workers to talk about what happened.
• Identify current needs.
• Offer workers advice, information and handouts on referrals and support agencies.
• Arrange debriefing and follow-up sessions to provide additional information about the event when available.

Debriefing (powerful event group support) is usually carried out within three to seven days of the critical incident, when workers have had enough time to take in the experience. Debriefing is not counselling. It is a structured voluntary discussion aimed at putting an abnormal event into perspective. It offers workers clarity about the critical incident they have experienced and assists them to establish a process for recovery.

Trained debriefers help the workers to explore and understand a range of issues, including:

• The sequence of events
• The causes and consequences
• Each person’s experience
• Any memories triggered by the incident
• Normal psychological reactions to critical incidents
• Methods to manage emotional responses resulting from a critical incident.

• Your supervisor or manager
• Human resources manager or officer
• Occupational health and safety officer
• Health and safety representative
• Your doctor

We take the wellbeing of staff very seriously. Should you feel concerned or threatened at any time there are a number of ways you can report this.

Concerning behaviours is where you are worried or concerned about a person’s actions or choices. It could be something obvious like sexual harassment or theft. It could also be something less obvious like unwanted attention or any other behaviour that is worrying and inappropriate e.g. revealing inappropriate knowledge of personal information.

Threatening behaviour is when you are fearful or feel that imminent physical danger to yourself or others is likely. Obvious threats could be an uttered threat to kill, harm another or damage property, an uttered threat to self-harm or suicide or any act of physical violence, production of a weapon etc. Not so obvious threats could be stalking, bullying, angry or aggressive communications.

For urgent support, each of the consulting rooms and the reception desk have a duress alarm. In addition, should staff be concerned for their immediate safety, they can dial 999 on the phone system which automatically generates an auto-email to all staff alerting them that there is an immediate safety concern.

For all non-urgent support, please report any concerning or threatening behaviours via our incident report.

• MAT Health Clinic Behaviours of Concern Policy
• ZERO Tolerance Policy

• MAT Health Clinic ABC Behaviour Assessment Form
• Acceptable Behaviour Template
• Incident Report Template

You will find the Challenging Behaviour Workplace Guide here.

• RACGP General Practice – A Safe Place