How do you deal with assholes when you can't kick them out?
November 15, 2018 4:26 AM   Subscribe

Say you work in an organization that provides a vital service and for that or some other reason really can't outright ban problem clients/customers/patients. What does your organization do when people are wildly abusive and inappropriate towards staff or each other?

I work in a clinic that serves a mix of folks, some of whom have serious mental illness and substance abuse issues. There are periodic incidents of patients being verbally abusive to staff or each other (using racial slurs, hate speech towards LGBTQ communities or immigrant communities) and we are struggling to address them appropriately. There is a lot of reluctance to outright discharge perpetrators because they would realistically have no other access to non-emergency healthcare. Does your organization work with similar demographics? Do you have ways of stopping these kind of incidents where the perpetrators can still access the services you provide?

(Yes the administration and our mall cop-esque security guards are aware of these incidents. Their response has not been helpful but we are hopefully working on that. I think having some suggestions of viable solutions would help. I had jokingly suggested we make perpetrators wear silly hats if they wanted to use the clinic which got me thinking that there may be more realistic but creative solutions out there)
posted by anonymous to Work & Money (8 answers total) 9 users marked this as a favorite
I'd be concerned that you have a duty of care to your staff and clients, so not excluding repeat offenders, especially if they're being abusive in relation to protected attributes, could open your organisation up to liabilities especially under discrimination legislation. Mental illness is not a cause or excuse for prejudice and hate.
posted by JonB at 4:56 AM on November 15, 2018 [16 favorites]

Can you just "send them to the back of the line" if they act out? If it's non-emergency service, then an extra few minutes shouldn't be significant, but annoying enough for them to stay on top of their social outbursts.
posted by seanmpuckett at 4:56 AM on November 15, 2018 [7 favorites]

This may not help because it sounds like your environment is more drop-in for a short amount of time, but I volunteer in a shelter and we have incoming clients sign a code of conduct with their initial paperwork that states pretty clearly what's expected when they are accessing services and what the consequences are. Then, if they violate that, a staff member sits down with them to fill in an "areas of improvement" form where they go over what happened, why it was in violation of the code of conduct, and what they can do to have it not happen again. They get three strikes on that before getting kicked out of the program. This is for relatively "minor" stuff... something like physical abuse or bringing drugs in would be an immediate discharge. Verbal abuse of other clients or use of slurs is probably on the edge and up to the staff's discretion.

Anyway, could you do some shorter term version of that - like a set of rules posted at the entrance ("please use respectful language" etc) and then a verbal warning followed by a softer punishment like saying they will have to come back another day?

I agree with JonB that the organization has a duty of basic care for staff and other clients. Even when services are's not fair to the other people accessing them to have verbal abuse thrown around.
posted by cpatterson at 5:36 AM on November 15, 2018 [20 favorites]

From an anonymous Mefite:
Ideally we start with a staffing and, corrective action plan with participant.

Consequences for not following that plan first lead to banning of auxiliary services like transportation, bus cards, and other incentives.

If group participation is an issue, they may be asked not to participate in groups.

If there is significant behavioral issue that can be solved with medication we may emphasize medication compliance as a part of continuing care.

Police escort off premises for the day during outbursts.

If there are safety issues we may request that person only come with an escort or have our security escort them.

Rules restricting arriving early and staying after appointments.

Issues that lead to safety of other people are the only thing that can get one banned. I have seen it happen. However, there are multiple service providers in the area, and likely an appropriate referral can be made.
posted by goodnewsfortheinsane at 6:29 AM on November 15, 2018 [1 favorite]

Ryan Dowd is a lawyer who works in a shelter and deals with a lot of different people who are experiencing homelessness as well as (often) other mental health issues. I subscribe to his newsletter which is about strategies for working with homeless people in libraries including a lot of "What do do when they are being jerks, even if you understand why they are being jerks" and it might be useful for your situation as well. He talks a lot about de-escalating and a lot of things I wouldn't think of such as body language and when to make jokes etc. I find his approach compassionate while still being like "Look we have a library to run here" and it's helpful.
posted by jessamyn at 6:34 AM on November 15, 2018 [23 favorites]

I am a queer person who has accessed non-emergency (and emergency) healthcare in a scenario that sounds not unlike what you describe. I agree that you can't really ban these people, but you can--and should--require them to leave and return another day. You have an obligation not just to these people, but to the other vulnerable people who use your services, and manage to do so without being abusive towards others.

Presumably you feel that all of your clients deserve to have safe access to healthcare and other essential services--but I can tell you from experience that if someone is ranting furiously about [demographic], the people in that demographic no longer feel safe. You can't prioritize both the safety of marginalized groups and the inclusion of someone who's actively making people in those groups feel unsafe--when push comes to shove, you either have to ask angry outbursts guy to leave, or you have to feel ok knowing that a nonzero number of people are going to leave or simply not return because it's clear that this environment is hostile to them.
posted by mishafletch at 7:01 AM on November 15, 2018 [18 favorites]

“There is a lot of reluctance to outright discharge perpetrators because they would realistically have no other access to non-emergency healthcare.”

I work in a similar clinic, and I’ve had similar clients. My take is this: It’s pretty standard to end treatment if someone repeatedly shows up inebriated, even though we view addiction as a disorder, not a choice.

YET—we also require that people show minimum self control (e.g. shooting up after outpatient therapy, not before) in order to maintain safety for those around them.

I’ve had clients with issues keeping their dislike of the skin color of admins to themselves. In my view, letting loose on an admin with a racist barrage is a very very different thing from a verbal tic, let’s say.

Further, allowing such behavior hurts clients who may be looking on, AND I would argue that it harms the perpetrator by reinforcing a behavior that sooner or later could be harmful to that person his/herself. In short, Bandura would have a heart attack.

My solution is to go back to patient bill of rights—if one client repeatedly infringes on other clients’ rights, 3 strikes and you’re out. It removes the whole clinicians and admins vs this person who will never get treatment again. And it establishes boundaries so that this client doesn’t come to a place where they really can’t get treatment ever again!
posted by executive_dysfuncti0n at 8:30 AM on November 15, 2018 [2 favorites]

Medication-assisted therapy clinics (methadone, suboxone, etc.) in my city are in this same spot, because methadone and associated social services, like therapy, can only be delivered by licensed clinics. They have a reputation for intolerance for this kind of behavior and seem to dismiss patients, or at least threaten to dismiss them fairly regularly. Something like throwing a chair (I witnessed this) would lead to immediate removal, but racist or misogynistic or sexist confrontations probably would not for the first incident. Additional counseling to address how the client deals with stress would be required, and the client would have diminishing access if the behavior didn't improve mightily. Of course, the directors then call around to other clinics to find someplace to take the client so he has access to methadone/suboxone. Unfortunately many recovering addicts have very short fuses and act out impulsively, something I have long felt makes them susceptible to substance abuse, but that's a personal observation. There is a lot of impulsive language, shouting, and angry outbursts in this population.
posted by citygirl at 11:07 AM on November 15, 2018

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