www.publicinvolvement.org.uk

The Observer reported in November that organisations were fighting back against 'morbid' and 'querulous' complainants. The persistent complainant is not a new phenomenon. The old public utilities held fat files on their local persistent complainants and the complaint managers used to swap tales of these obsessives and the latest bizarre communications they had received from them - complete with the capital letters and green ink. In work I have done with Ombudsmen - especially the Legal Services Ombudsman - the comments from a minority of complainants researched alleged the most lurid conspiracies at the rotten heart of the nation.

These complainants however could never just be seen as another joke after the Dunblane killings when Thomas Hamilton killed one teacher and 16 children in a primary school gym. Subsequent enquiries showed that Hamilton was a champion complainant. No one who came across him and challenged his behaviour or threw doubt on what he was doing in his boys' clubs escaped being complained about. The Ombudsman handling local authority complaints in Scotland then upheld a complaint he brought against a regional council. Endless police and other public authority time was spent on enquiries generated by his prolific letter writing and allegations of corruption and bias in high places.

Lord Cullen's report on the Dunblane massacre sets out in the chapter on events in Hamilton's life how Hamilton used complaints to distract public authorities from looking too closely at his conduct and reverse or defer decisions that affected his actions. Cullen wrote

"It may be noted that throughout the years Thomas Hamilton's stream of letters of complaint and self-justification continued unabated. He expressed a complete lack of faith in any of the complaints procedures and tried on various occasions to enlist the help of his MP. He frequently wrote to parents defending himself and attacking the police. He tried to involve The Scottish Office, complaining about the way that the police were handling his complaints, with the result that the police had to keep The Scottish Office regularly up to date on what was happening. DCC McMurdo (a policeman involved) became obviously exasperated at what he described as his irrational outpourings in vindictive correspondence. The police were obliged to follow up persistent complaints which were quite absurd. He considered Thomas Hamilton to be bitter and petty-minded, perverting the healthy relationship between police officers and the Scout movement into something sleazy and dishonourable. He found it difficult to try to reason with a person whom he described as a zealot."

His opinion was shared by many and yet Hamilton was left alone with his guns. No one imagined what he would do.

So it does not seem that inappropriate that psychiatrists should become involved. The earliest reference I could find was a presentation by Dr Grant Lester to the Royal Australian New Zealand College of Psychiatrists, Forensic Subsection Conference, Queenstown, New Zealand, September 2002. It was referenced in a 2003 report by Peter Gibson of Craigforth Consultancy and Research on Persistent Complainants.

Peter's report acknowledged the importance of this new work and asked the doctor to produce guidance for the Craigforth paper on how complaint managers could respond to those complainers expressing the behaviours of morbid querulousness. These are reproduced below.

GUIDELINES FOR COMPLAINT MANAGERS FROM DR GRANT LESTER

RECOGNISE:

• Imbalance between loss and level of preoccupation;
• That demands vary, particularly when met;
• Contagion of complaint - i.e. not just the initial service provider but now others, including those involved in 'aiding' complaint resolution;
• Communication styles - i.e. see my research on life domain losses accruing from pursuit of complaint;
• Consider 'early' transfer to experienced officer or team.

BE AWARE OF:

• Context - i.e. their presentation varies dependent on your relationship with the individual;
• Adequate time and information - i.e. always gather clear history and allow them unstructured time to speak, this allows for best chance of evaluating preoccupation, individuals goals, secondary losses, etc;
• Keep yourself and themselves calm and reframe their goals from 'revenge and vindication' to reparation
• Adherence to professional boundaries - i.e. don't become their 'knight in shining armour'. Avoid offering excessive 'emotional' support, this is particularly addictive for them, and if withdrawn they may experience excessive if not spectacular 'withdrawal symptoms'.
• Firm rules - i.e. re contact, availability.
• Avoid adding to the stock of real grievances -i.e. be efficient;
• Transparent, written communications - avoid verbal agreements; don't talk/gossip about them to others.
• Acknowledge error. Confront (gently) misconceptions. Offer practical solutions - that can be done. Clearly label dreams and unrealistic expectations - that will not happen;
• Avoid becoming their saviour or the embodiment of institutional resistance;
• Strive for total transparency:
• • Write don't just phone
  • Don't write anything which claimant can't see (that doesn't mean censor);
• Try constantly to distinguish between the realisable and the unrealisable;
• Awareness of sensitivity to hierarchy - i.e. they respond best to hard messages/bad news from the 'boss'.
• Focus on real grievance and real price being paid by claimant by their pursuit of quest;
• Don't cut off all pathways to progress of claim unless unavoidable;
• Take all threats very seriously - i.e. including those of self harm. Catch 22 - do not lightly mention need for psychiatric help, as this often precipitates acute anger response;
• Share the load - i.e. they are exhausting emotionally and time wise and exhausted staff respond poorly and at times inappropriately. Involvement of 'boss' or other experienced officer is essential at this time;
• Remember protecting your and your staff's emotional and physical health and safety must have priority;
• Planned termination - i.e. if ceasing involvement do it over time with slow steps;
• 'Leave a Door Open' - i.e. for the most difficult/preoccupied/upset termination plan may allow for a single ph contact on specified basis over some time;
• Folie a Deux - don't get into a threatening duel, if they have threatened or verbally assaulted, or frightened staff, don't threaten with police unless you intend to follow through - i.e. rules of engagement should be clearly stated at commencement of contact, e.g. if abusive, threatening behaviour police will be involved.

The full report Review Of Approaches To Persistent Complainers has been published by Craigforth Consultancy and Research in 2003. It is a record of Craigforth's research into this area and the analysis and the conclusions and recommendations are Craigforth's alone. The research was commissioned by the Scottish Executive's NHS Complaints Working Party. The Scottish Consumer Council undertook to set out the research topic and to engage suitable researchers. The report does not reflect the policy of the NHS Complaints Working Party or of the SCC.

Copies of this report are free in electronic version. Email office@craigforth.co.uk and request a copy. You will be sent the main report (28 pp) and a separate appendix (16 pp).

I have referenced this work fully not just for reasons of professional courtesy. First it is a good report that throws helpful light on a problem that those of us who are in favour of better treatment for complainants may have played down for fear of spoiling our case. Also I remember with pleasure how Peter and I worked together developing many approaches and ideas that we hoped would benefit complainants when we ran The Customer Management Consultancy. Finally because Peter is gravely ill and I wanted him to know how much I believe he has contributed to the consumer cause over many years in Scotland and elsewhere. We wish him very well.