Power, Respect and Violence in Human Service Work

Issues of social justice are particularly complex in health care and human service settings where the rights of patients and workers need to be considered simultaneously. This paper presents qualitative data gathered through focus groups of both patients and workers in six addiction treatment facilities where the incidence of violence directed at workers was very low. Qualitative analysis indicated that a philosophy of care based on mutual respect between patients and workers was one of the major reasons for the low levels of violence. Workers maintained a practice of listening and treating clients with respect while recognizing and supporting their rights for procedural justice. Patients reciprocated by acting to prevent violence among themselves which served to protect workers before conflict could escalate into violent acts. We performed a separate qualitative study of another social service institution that cared for patients with severe disabilities. In this institution all the emphasis was placed on patient rights, with little, if any, concern for the rights of workers. For example, workers were required to physically intercede if clients were fighting and take the blows on their own bodies. Incidents of violence directed at workers were extremely high in this facility. We will discuss these findings in relation to Gilligan's research among prisoners where violence became a means to maintain and achieve respect. We will conclude by examining some of the political changes that will be necessary to achieve both non-violence and social justice for workers and their patients.