Rising abuse towards mental healthcare workers

Working in healthcare has never been an easy calling. With the added demands brought about by the pandemic, healthcare worker abuse has been dominating the headlines in recent times, in both public (https://www.straitstimes.com/singapore/politics/more-healthcare-workers-in-public-institutions-getting-abused-or-harassed) and private settings (https://www.todayonline.com/singapore/clinic-assistants-abuse-patients-gps-be-better-protected-1878696).

 In April 2022, a video (https://www.todayonline.com/singapore/police-probe-clinic-staff-kicked-pram-woman-flung-brochures-1878606) of a clinic assistant shouting and damaging the property of a customer surfaced and made its way around social media. It was later reported that the clinic assistant had suffered physical and verbal abuse from the patient prior to her outburst. 

As a mental health clinic, we empathise with the distress that our patients face. Many of the issues that might bring a person into a mental health setting are immense and debilitating. 

But abuse of healthcare workers, including mental healthcare workers, is also a concerning issue and has been on the rise in recent years. 

 

The Different Types of Healthcare Worker Abuse

Though we often think of physical abuse as the only form of abuse, abuse presents itself in many guises. The most common form of physical abuse is when a patient makes physical contact with a healthcare worker or throws objects at them. These actions are often unprovoked and can result in serious injury and embarrassment to the healthcare worker.  

More commonly in a mental health setting, healthcare workers experience verbal abuse. Verbal abuse can occur either as outright verbal abuse or what is sometimes known as 'borderline' abuse. Outright verbal abuse happens when a patient berates healthcare workers by shouting, hurling expletives, or making discriminatory or racist remarks. 

Borderline abuse is often less obvious but equally insidious. Such abuse often arises from backhanded or snide comments to healthcare workers, insulting their abilities and qualifications, or being disrespectful. While borderline abuse in isolated incidents might not seem to be as damaging or severe as outright verbal abuse, such abuse can have long-lasting on healthcare workers if sustained over a period of time. 

 

Mental Health Impact of Abuse on Healthcare Workers

We often forget that healthcare workers are human too.  

We experience and go through the same emotions that you feel. When a mental healthcare worker is constantly dehumanised or verbally assaulted by patients, it takes a toll on our mental health. 

In 2021, the Ministry of Health reported 1,400 cases of healthcare worker abuse, a 16% increase when compared to 2019, prior to the Covid-19 pandemic. In the same span of time, healthcare workers seeking counselling services have increased by 169%. Separately, it was also reported that the safety and well-being of front-line healthcare workers in private clinics are often overlooked as compared to those working in the public healthcare setting. 

Prolonged abuse and lack of appreciation can be traumatic for healthcare workers, resulting in mood and emotional difficulties. Healthcare workers suffering from constant abuse from patients are left feeling unmotivated to carry on with work or plagued with feelings of dread, increasing the possibility of occupational burnout as well. More importantly, such difficulties affect the ability of healthcare workers to provide their best at providing healthcare services to patients and reduce the quality of care received by patients. 

The frequent toll of abuse ultimately results in resignations or leaving the healthcare industry altogether. This phenomenon can have a lasting impact on the healthcare industry, such as longer waiting times due to a lack of manpower, overworked healthcare workers that can compromise on providing a quality healthcare service, and rapidly rising healthcare costs. In the long run, abusive patients ultimately result in lower healthcare quality.

 

Why do patients abuse healthcare workers?

There are several reasons why patients might unknowingly abuse healthcare workers.  

Some patients might act out due to mental health conditions or because they are not used to seeking medical help. Others might be angry about their condition or the lack of progress made, and some might have faced abuse in similar settings and are projecting their anger onto healthcare workers. 

When someone you care about is suffering from a mental health condition, it's difficult not to be worried. The unknown and a lack of understanding about a medical or mental health condition and its prognosis can be frightening. This overwhelming fear coupled with limited healthcare resources might lead to patients and their caregivers believing that a healthcare worker has uncaring attitudes toward their needs. While this perceived neglect varies by patient and caregiver, they may feel justified in expressing their anger if they feel their medical or psychological healthcare needs are neglected. 

Whatever the reason, it is important to remember that healthcare workers are not responsible for the patient's condition, and abuse towards them will not result in a better outcome for the patient.

 

Help us help you

At times, it might feel as if the staff is deliberately resisting a patient’s wishes, especially when a patient request is not in line with legal regulations or an internal policy.  

We ask that patients understand that mental healthcare workers have a duty of care to all patients and must follow certain ethical and legal guidelines in order to ensure quality care for all. These guidelines are in place to protect patients, staff, and the healthcare organisation from potential harm. 

Sometimes, what a patient perceives as mistreatment might be adherence to guidelines. For example, a therapy modality might not be clinically indicated or advisable or a patient might want to see a specific healthcare worker when it is not possible due to scheduling conflict.  

Other examples might include:

1. not being able to perform a requested therapy modality, assessment or test.

2. not being able to support a diagnosis or management plan where it is clinically inappropriate.

3. seeking a parent or guardian's consent in respect of a minor before providing non-emergency services.

4. in a private healthcare setting, enforcing a last-minute no-show or cancellation policy to ensure that patients have fair access to limited healthcare services.

5. an obligation to verify that a patient has consented to receive a healthcare service.

 

How can we work together without abuse?

Healthcare workers usually choose to work in this demanding industry because of our passion for helping those in need. It is important to remember that healthcare workers and patients work on the same team; both share a common goal of providing every patient with the help and support they need.  

If you are feeling frustrated, try to communicate your feelings in a calm and respectful manner. We want to help you, but we can only do so if we can understand what you need. If you remain unhappy with a response made by staff, we recommend that you speak to a manager or supervisor about your concerns rather than expressing their frustrations to the healthcare worker in question.  

We take each and every complaint seriously. When a complaint is received, our management conducts a thorough investigation into the circumstances of the complaint. If a complaint is valid, we will take the appropriate disciplinary action against our member of staff. Disciplinary outcomes for staff include counselling, supervision by managers and/or clinical supervisors, compulsory refresher or training courses, issuance of verbal and written warnings, being placed on administrative leave, or in appropriate circumstances, being asked to leave the organisation. 

At the same time, we have an obligation to ensure that our colleagues feel safe in their work environment. We do not tolerate any form of abuse towards our staff whether physical or verbal. We will refuse service to anyone who engages in abusive behavior. 

We're Mental Health Workers but our Mental Health Matters too.