This information guide is
intended for psychiatrists who may be being stalked. The
information should be used as a guide only and is not a substitute
for professional advice. If you need further advice and support,
please contact the Psychiatrists’ Support Service or one of the
organisations listed at the end of this information guide.
Stalking is a problem behaviour
involving unwanted communications or approaches that cause fear or
significant distress, and that are repeated over more than 2 weeks
(Mullen et al, 2009). It can include, for example,
telephone calls, face-to-face contact, gifts, complaints, threats,
libel, property damage or even assault.
Health professionals can be stalked
in the workplace by:
- patients or their relatives
- outsiders (often ex-partners) who
intrude into the work situation.
The risk of being stalked by a
patient or a patient’s relative is between 5% and 10% in a year,
and around 20% over the course of a career (Purcell et al,
2005; Mullen et al, 2009). There is some variation
depending on profession and also within psychiatric subspecialties:
for example, forensic psychiatrists and general adult psychiatrists
appear to be at higher risk, whereas the risk appears to be lower
for old age psychiatrists and neuropsychiatrists. In addition, the
lifetime risk of being stalked by an ex-partner or anyone else is,
on average, around 8% for women and 2% for men (Purcell et
al, 2005; Mullen et al, 2009).
The nature of stalking
Patients who stalk are usually
either motivated by resentment at what they perceive as inadequate
or unreasonable treatment, or seek intimacy, that is attempt to
establish a romantic or otherwise close relationship.
Stalking may begin gradually but
often persists for many months, and for over a year in a half of
cases of stalking of psychiatrists (Mullen et al,
Harm caused by stalking
Even brief intense episodes of stalking can be distressing;
serious harm, such as physical or sexual assault, is more likely
with more extended patterns of harassment. Between 20% and 40% of
victims experience symptoms of mental disorder as a result of being
stalked (Pathé & Mullen, 1997; Mullen et al,
Patients and relatives driven by resentment make vexatious
complaints to hospital administrators, the General Medical Council
or similar bodies in 20–30% of cases (Mullen et al, 2009).
Intimacy seekers may make complaints following rejection of their
advances, sometimes alleging sexual impropriety. The risks of being
threatened are high in both resentful and intimacy-seeking stalkers
but assault is unusual, being reported by around 8% of
psychiatrists who were stalked (Mullen et al, 2009).
The risks presented by colleagues
who stalk depend on what is motivating them. If it is resentment,
then complaints, threats and malicious rumours are the main
Stalkers from the victim’s outside
life who intrude into the workplace are usually rejected
ex-partners. This is a high-risk group and such intrusions,
particularly if they involve force or obvious trespass, are
warnings of imminent assault (Mullen et al, 2009).
Colleagues may be caught up in the violence perpetrated by these
Managing stalking and minimising the
The stalking of mental health
professionals by patients is sufficiently common, and potentially
troublesome, that all workplaces should have clear policies and
procedures in place to support and protect victims and manage the
perpetrators. In practice it is unusual for trusts to have
dedicated policies, but stalking may be covered by a section within
bullying and harassment policies.
The policy on stalking should:
- provide a mechanism for the
reporting of stalking or possible stalking to an appropriate
manager at an early stage, by the victim or others
- make it clear that such reports
should be taken seriously and dealt with promptly by thorough but
- recognise that stalking is only
very rarely the fault of the victim (for example, because they have
not maintained professional boundaries); the victim should be
supported and should not be blamed for the stalking
- allow for the involvement of a
union representative or other adviser if appropriate
- maintain confidentiality for the
victim and the patient (stalker) so far as is possible with the
safe management of the situation
- allow for the provision of
counselling where necessary
- set out how workplace safety plans
should be devised in the event of serious or particularly harmful
- such as where the victim or
colleagues are at risk of intimidation or assault by the
- provide access, where appropriate,
to legal advice for the victim, and assistance in liaison with the
police or in obtaining a non-molestation order or other
- allow for the inclusion of
training in spotting the early signs of stalking and managing it
appropriately as part of induction programmes and/or other training
Other policies are also relevant.
For example, there should be effective, well-enforced policies on
confidentiality of staff (and other) information, to minimise the
chances of it being obtained and used by a stalker, and on staff
identity and security, to minimise the chances of stalkers who are
not employees gaining access to private areas of the workplace.
In addition, to minimise the risk
of stalking by its employees, the employer should, in consultation
with any staff unions or professional bodies, do what it can to
foster an open and supportive workplace culture, in which
grievances and interpersonal conflicts can be aired and resolved
swiftly and sensitively. They should also consider the potential
for stalking or other inappropriate behaviour by candidates for
employment as part of the recruitment process.
Responsibilities of the
All mental health professionals
should be aware of the possibility of being stalked, particularly
by patients, and should ensure they receive appropriate training in
recognising and managing stalking. More generally, they should be
aware of the risks inherent in their therapeutic activities
(especially those involving an intense, exclusive relationship,
such as psychodynamic psychotherapy) and should understand and
maintain appropriate professional boundaries at all times. They
should make patients aware of those boundaries and set realistic
expectations (e.g. ensuring the patient realises that a court
report will not necessarily be favourable). Professionals should
follow their employer’s policies relating to stalking, such as
those on confidentiality and personal safety.
Where a patient is viewed as posing
a risk of stalking, they should only be seen in well-staffed
facilities with suitable security arrangements. The use of a
chaperone should be considered, particularly for physical
A mental health professional who is
being stalked should take the following steps:
- Recognise the possibility that
they are being stalked at an early stage. Approaches outside the
workplace, repeated inappropriate communications, expressions of
inappropriate affection, following, repeated loitering near the
professional or their home, office, or car, all are warnings of
possible stalking. Mental health professionals are prone to
minimise and normalise the behaviour of their patients, and may try
to explain away obviously inappropriate actions as ‘transference’
or as illness-related. Although this might explain the stalker’s
behaviour, it does not change the fact that it must be recognised
and dealt with as stalking.
- Inform colleagues of their
suspicions. This provides an opportunity for a reality check. The
usual enquiry is in the form of ‘I wonder if this might be
stalking’. The usual answer is ‘That’s stalking for sure’. Just
occasionally, reassurance may be the appropriate response.
- Inform the appropriate manager at
an early stage, following the employer’s policy covering stalking,
and cooperate with the requirements of that policy.
- In consultation with the relevant
manager, inform colleagues (particularly secretaries and
receptionists) of the stalking, so that they do not inadvertently
disclose information to the stalker or otherwise assist them.
- Inform the stalker, once only and
in clear language, that their communications and approaches are
unwanted and cause fear and distress. This message should be given
with a colleague present and should be followed up in writing; it
should go on to explain the consequences if the stalking continues
(e.g. prosecution for harassment). In some cases, it may be more
appropriate for a colleague, manager or legal representative to
give the stalker this message.
Keep a careful record of all
relevant events, including a detailed record of all stalking
behaviours experienced, all discussions that have taken place about
the issue, and what actions have been taken. This should be
countersigned by a colleague or witness where possible. A copy
should be given to any medical defence organisation involved in the
Also keep all letters from the
stalker, tapes of recorded messages, copies of any messages or
texts (with the time and date), and a record of approaches and
intrusions (including the time and place). Such records are
essential for the police to take action if and when they are
Cease all further contact with the
stalker and do not respond directly in any way to any further
stalking behaviours (e.g. do not take or return telephone calls, do
not reply to letters, ignore approaches). All communications should
be passed on to the appropriate manager under the stalking policy,
or to a legal representative, for a response; approaches should be
dealt with by security staff or the police.
If the stalker is a patient,
transfer their care to another professional immediately, making a
careful record of the transfer and the reasons for it. Only in
exceptionally rare circumstances, such as when practising in a very
isolated geographical area where no other suitable mental health
professional is available, should any form of professional contact
continue. In such exceptional circumstances, all contact should
follow a plan carefully devised with managers to ensure safety, and
face-to-face contact should only occur with a co-therapist,
colleague or chaperone present.
If the stalking continues, approach
the police, accompanied by a senior colleague or manager, and
insist on criminal prosecution.
Responsibilities of colleagues
The colleagues of a professional
who is a victim of stalking should:
- not add to the victim’s plight by
overtly or covertly suggesting that being stalked represents a
failure to manage a clinical situation; both the experienced and
the inexperienced are equally vulnerable to being stalked (Purcell
et al, 2005)
- provide tangible support (this
includes accepting the transfer of the stalker if requested);
stalkers tend to stick to their initial victim and few, if any,
will begin stalking a new therapist.
Stalking intruding into the
This should always be a matter for
the police, almost irrespective of the victim’s wishes, because of
the high rate of subsequent assault following such intrusions. The
line manager of someone who is being stalked may find this a
particularly difficult decision to make and may wish to discuss it
with a senior colleague and/or their medical defence organisation
Coping with being stalked
Stalking is always anxiety
provoking and if it continues, it usually causes psychological and
social damage to the victim. Stalking can produce a state of
chronic fear which disrupts concentration, sleep and effective
function as well as causing the victim to reduce their social
activities. Prolonged stalking is associated with the emergence of
depressive and chronic anxiety symptoms, with suicidal ruminations
in up to 25% of victims. Victims of stalking, like many other types
of victim, tend to blame themselves despite bearing no
responsibility for what is being done to them.
To reduce the impact of stalking
- inform colleagues, family and
friends so that they can
- provide support and also protect
themselves from the stalker, who might victimise them at some
- seek help and advice from those
experienced in managing the stalking situation
- take up offers of help from the
employer and others, such as counselling services or legal advice
- make full use of the protections
provided in the workplace and by the police and criminal justice
- remember that being stalked is a
risk inherent in the therapeutic process, not a sign of being at
Sources of further help and support
Royal College of Psychiatrists
21 Prescot Street,
London E1 8BB
Tel: 020 7235 0412
Network for Surviving
A registered charity dedicated to
support those affected by stalking.
After her daughter Suzy
disappeared in 1986, Diana Lamplugh founded this personal safety
trust. It offers advice to children and adults to help them stay
safe and recognise potentially dangerous situations.
Tel: 0845 30 30 900
Victim Support helps people cope with the effects of crime. There
are separate advice sections for people living in England and
Wales, and those living in Scotland and Northern Ireland.
Tel: 0808 2000 247 (National Domestic
Women’s Aid offers support for women and children who are the
victims of stalkers.
Stalking Resource Center is part of the
American National Center for Victims of Crime.
An online community of people who have
been victims of stalking.
- Mullen, P. E., Pathé, M. &
Purcell, R. (2009) Stalkers and Their Victims. Cambridge
- Pathé, M. & Mullen, P. E.
(1997) The impact of stalkers on their victims. British Journal
of Psychiatry, 170, 12–17.
- Purcell, R., Powell, M. B. &
Mullen, P. E. (2005) Clients who stalk psychologists: prevalence,
methods and motives. Professional Psychology: Research and
Practice, 36, 537–543.
- Surviving Stalking, by
Michele Pathé (Cambridge University Press, 2002): a handbook for
victims of stalking.
- Stalking and Other Forms of
Harassment: An Investigator’s Guide, by Hamish Brown
(Metropolitan Police Service, 2000); available at the Metropolitan
handbook for investigating stalking cases, with advice for
Written by Professor Paul
Mullen, Dr Sean Whyte and Dr Ronan McIvor for the Psychiatrists’
Support Service, Royal College of Psychiatrists.
© Royal College of Psychiatrists 2010
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