Let us prey...

In today's world of easy access to information, it is becoming more common for doctors to be the stalker's target. Ronan McIvor gives some advice to help minimise your risk of being stalked by patients and also what to do if you are being stalked

Have you ever wondered on how many lists and databases your name and personal details are stored? Some are obvious, such as professional and financial organisations, others less so. Personal information is relatively easy to come across. I was surprised to see how many psychiatrists, including forensic psychiatrists, provided details of home address and telephone number in the Royal College of Psychiatrists Membership List, last published in 2000 (which is accessible to members of the public in libraries and public buildings).

The internet has made the process of locating personal information even easier. For example, your address and an aerial photograph of your house can be obtained within a few minutes, complemented by the names of your neighbours, from www.192.com and other websites.

For most people, this intrusion is somewhat irritating but of no great concern. For medical practitioners and other healthcare professionals, the risks may be higher, particularly if disgruntled or challenging patients actively seek out such information for the purpose of harassment or threat.

What is stalking?

Stalking is the wilful, malicious, and repeated following and harassing of another person that threatens his or her safety,¹ and can involve anything from unwanted approaches or surveillance to specific or implied threats, and contact with the victim's family and friends. Doctors are at particular risk of being stalked by their patients primarily because of the nature of the doctor-patient relationship and the prevalence of mental illness and personality difficulties in this population.²

A recent American survey of clinical staff in an adult inpatient psychiatric service found that more than half had been the target of stalking, threatening, or harassing behaviour.³ Stalking can result in distress and psychiatric morbidity for the victim, with the associated threat of physical or sexual violence.⁴

Minimising the risk of stalking

How can doctors and other health professionals reduce the risk of being stalked and protect themselves with minimal effort and without compromising clinical practice? Several simple strategies can minimise risk (box 2).

Editing the electoral register

The UK electoral register, comprising full and edited versions, is available from libraries and town halls and is a highly accurate way of obtaining personal information. The full register contains everyone's details and is used for electoral purposes and sold to credit reference agencies. It is available for public inspection, but only under supervision and only handwritten notes can be made from it. It is possible to opt out of the edited version, which is available to sell to anyone or any organisation for any purpose. Choose this option when completing your annual electoral registration form sent out by your local council.

Being internet smart

The advent of the internet has resulted in an explosive increase in the ability to access personal information but it is still possible to limit availability.⁵ For example, removing yourself from online search engines such as www.192.com is reasonably easy (email feedback@192.com). However, assume nothing is secure on the internet. It is best to register for sites and services using a work address or post office box, and use a pseudonymous email address and details for public activities and expressions of opinion, such as bulletin boards and online discussions. Consider using a firewall programme to protect your computer from intruders (for example, for a reasonable effective free virus scanner visit www.grisoft.com/us/us_dwnl_free.php).

Restricting your financial history

Access to credit reference agencies, such as www.cpa.co.uk, can reveal details of your financial history. Entry to such sites is usually restricted to fee payers or business users, but is another potential source of information for the determined stalker. The two large credit reference agencies in the United Kingdom (Experian and Equifax Europe) state they have stringent checks in place to ensure credit reports are only sent to those who legitimately request them. The accessing of third party credit information by an unauthorised individual is, of course, unlawful. It is difficult to remove your name from such agencies, but they do have a service that will alert you to significant changes in your credit report.

What to do if stalking begins

If you think that you are being stalked, take it seriously from the beginning (box 3). After receiving the first letter or contact, tell the patient clearly and unambiguously that their behaviour is unacceptable and should stop. This will often be enough. If it continues, inform colleagues and have no further contact with the patient.

Get the police involved sooner rather than later, as a spoken warning may be enough to stop further harassment. Encourage the police to activate legal sanctions quickly if necessary. The Protection from Harassment Act 1997 (www.legislation.hmso.gov.uk) has made it much easier to seek legal redress in such cases. The patient can be assessed under the Mental Health Act 1983 (England) if there is clear evidence of mental illness.

In certain situations, you may register under an assumed name on the electoral register, with permission. There is no legislative provision for anonymous registration, but individual electoral registration officers are permitted to use their discretion if the need arises. Further information can be obtained from your arbitration and electoral services officer at the local town hall (or at www.electoralcommission.org.uk).

If you have been a victim of stalking and would like to help with further research, please email Ronan McIvor for further details.

1. Meloy JR. The clinical risk management of stalking: "someone is watching over me..." Am J Psychother 1997;51:174-84.
2. Pathe MT, Mullen PE, Purcell R. Patients who stalk doctors: their motives and management. Med J Australia 2002;176:335-8.
3. Sandberg DA, McNiel DE, Binder RL. Stalking, threatening, and harassing behavior by psychiatric patients toward clinicians. J Am Acad Psychiatry Law 2002;30:221-9.

4. Kamphuis JH, Emmelkamp PMG. Stalking: a contemporary challenge for forensic and clinical psychiatry. Brit J Psych 2000;176:206-9.
5. Deirmenjian JM. Stalking in cyberspace. J Am Acad Psych Law 1999;27:407-13.