Behaviour of concern – MAT Health Clinic

About us

MAT Health Clinic (MHC) is a General Practice which provides a wide range of medical services to all age groups. A specialised team of male and female general practitioners (GP’s) work at the clinic along with allied health service providers, nursing staff and an administration team.

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Challenging behaviour refers to difficult behaviour exhibited by an individual that impacts the physical safety of themselves or others.

Our Administration/Reception staff should have a basic understanding of how to identify and respond to behaviours of concern(also known as challenging behaviours). Being aware of factors that contribute to difficult patients and being prepared to address them will go a long way toward preventing these behaviours in the first place.

Definition of Behaviour of Concern

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.

Why patients may be difficult?

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
Identify the Problem

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.

Challenging Behaviours may take the form of:

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


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

How do we handle difficult patients?

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.

Strategies for dealing with difficult people
  1. Listen– try to hear what they are really upset about. Listening is key when trying to de-escalate a situation quickly.
  2. Stay Calm– if you can see the situation getting out of hand quickly, stay as calm as possible. Often meeting anger with anger, or coming back defensive with a difficult person, will likely make the situation worse.
  3. Don’t Judge– try not to judge this person. Sometimes a person reacts with anger or is unreasonable when they are going through something and don’t know how to express it.
  4. Reflect respect and dignity toward the other person– always keep the situation as level and even as possible. Belittling or speaking down to the difficult person, will not solve any issues quicker.
  5. Look for the hidden need– what is really going on with this person? Are you able to figure out what they are really so upset about?
  6. Look for others around you who might be able to help– Sometimes bringing in another person can diffuse a situation.
  7. Don’t demand compliance– recognise that this person has the right to feel upset and angry. Even though this might not be the way you would have expressed it, trying to tell someone to “calm down” never works.
  8. Saying, “I understand,” usually makes things worse– trying to empathise with the person can go a long way. This person is upset or angry because they are not feeling heard or might need something they do not know how to ask for. Saying you understand will often show the person you care about the outcome.
  9. Avoid smiling, as this may look like you are mocking the person– even when someone is being ridiculous, smiling or laughing can make you seem insensitive.
  10. Don’t act defensively- it is easy to take things personally when you are dealing with a difficult person. Try to understand their side and communicate as effectively as possible to make them hear your side.
  11. Don’t return anger with anger– this often just adds fuel to the fire.
  12. Don’t argue or try to convince the other person of anything– acting defensively, raising your voice, or returning the expressed emotion will just make the other person angrier and the solution to the problem further away.
  13. Keep extra space between you and the other person– make sure you give this person enough physical space so that they feel safe and respected during this encounter.
  14. Saying, “I’m sorry,” or, “I’m going to try to fix this,” can go a long way toward defusing many situations.
  15. Set limits and boundaries- listening and understanding is important in dealing with a difficult person. But you also have a right to speak up for yourself if they are speaking to you disrespectfully.
  16. Trust your instincts– If you feel like this is a lose-lose situation, tell the person you should talk about this another time when you are both a little calmer. And if you feel like you might be in danger, get out of there as soon as possible.
  17. One response does not fit all– everyone reacts in a different way. And not everyone can be reasoned with. Understand that you will have to adapt to different situations when dealing with difficult people.
  18. Debrief– afterwards, try talking to someone or writing out what happened. This can help you deal with the situation in a healthy manner.
  19. Discharge your own stress– going for a walk or taking a moment for yourself after these types of encounters can really help you get back on track.
  20. Give yourself credit for getting through an uncomfortable situation.
Procedure for dealing with patient aggression

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


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
Procedure for dealing with an intoxicated patient

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
When is defusing conducted?

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.
Where to get help?
  • 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.