The Client from Mars... How to Deal with Unstable or Mentally Ill Clients

Mrs. Smith comes to your hospital with an emaciated and dehydrated dog named “Gracie”. Gracie is in critical condition, has very poor quality of life, and needs immediate fluid resuscitation and nutritional support. Even with aggressive treatment, Gracie’s prognosis is extremely poor. During the appointment, Mrs. Smith gives a long-winded, confusing and nonsensical monologue about everything from her ex-boyfriend to what she had for breakfast that day. It becomes clear to you that she cannot talk coherently about Gracie’s condition.

You try multiple times to tell Mrs. Smith about the treatment Gracie needs as well as broaching the subject of euthanasia. All your attempts fail and the only thing Mrs. Smith will talk with you about is the length of Gracie’s toenails.

From this situation it is hard for you to know if Mrs. Smith is under the influence of alcohol/drugs, or is truly mentally ill. What you do know is that you will not be able to help this patient or client in the way that you would like to. Working with these types of clients, while uncommon, is very frustrating and can cause you and your staff great distress. The key to working with unstable clients is to realize that you cannot change the situation and to set very specific limits.

Strategies to Try:

Stay calm
Recruit another staff member to team the case with you
Make your physical safety your first priority and do not stay with the client alone or after hours
Treat the client with ordinary respect but stay on the specific topic and do not indulge them in their ramblings
Set limits and inform them that you cannot help them with anything but the specific issue regarding their pet—tell them that they cannot stay unless they discuss only the topic at hand
Ask the client if there is a friend or family member that you can call to come and support them (and YOU) with the situation
If there are no family or friends, ask the client if there is anyone else you can call (many mentally ill people are under the care of a psychiatrist or therapist—calling them may be helpful)
Follow your own ethical guidelines regarding the animal’s physical well-being and safety if necessary
Call the police if the client becomes threatening, abusive, or refuses to leave your hospital
Understand that there is very little you can do in this
situation and do not blame yourself

Why Are These Types of Clients So Upsetting? What Can I Do About It?

Unstable clients create a barrier in your ability to help your patients. It is hard to see a pet suffer at the hands of an unstable person and to be helpless to change it. However, it is important to understand your limits in these situations and to not blame yourself for being unable to change it.
There is a reason why some mentally ill people are called “chronic.” The greatest communication skills in the world may make little or no difference. Even if you have a trained psychiatrist in the room with you, there may be no different outcome. Understand that this is NOT a failure on your part.
It’s upsetting to interact with people who are unstable or incoherent. You may feel sorry for them and wish that you could change their circumstances or you may feel threatened or even frightened by them. You may also be concerned for your staff and feel that you need to “protect” them from this type of client. These types of situations are draining and you need to take extra care of yourself afterwards.
Clients such as these are hard to “let go of.” De-brief with your staff and offer support to each other. Remind your staff of your successes.
When you leave work, make an effort to do something fun and nurturing for you. Spend time with family and friends who remind you that there is more to life than work.
Remember that you cannot change the world. It’s an unfortunate fact of life that there are some people, animals, and situations that you cannot change. Focus on the times when you really have made a difference.

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