Violence at Work: Frontline Employees Facing Customer and Patient Violence

Workplace violence is not only physical assault. Read how customer and patient violence affects employees, employers' obligations and steps for prevention.

The insults a call centre agent hears all day, a customer waiting at a counter slamming a hand on the desk, a patient's relative threatening a healthcare worker in the emergency department, or shouting directed at a cashier in a shop... All of these fall under the heading of workplace violence. In many organisations these events are brushed aside as "part of the job"; the employee is expected to be patient, smile and carry on. Yet violence from customers and patients is a psychosocial risk that directly affects employees' mental health, job safety and the quality of the organisation's service. In this article I look at the violence frontline workers face, its causes, the employer's legal framework and concrete steps organisations can put into practice straight away.

What Is Workplace Violence and How Common Is It?

When people hear "workplace violence", they usually think of physical assault. But the concept is much broader: verbal abuse, shouting, humiliation, threats, intimidation, exposing someone on social media and sending persistent, frightening messages also come under it. For frontline workers, the most common form is not physical contact but verbal and psychological violence.

International data show the scale of the problem. According to the International Labour Organization's 2026 report on the psychosocial work environment, 23% of workers worldwide have experienced violence or harassment at work at least once, and the most common form, at 18%, is psychological violence (ILO, 2026). In the OSH Pulse survey of more than 27,000 workers in Europe, 16% of workers reported being exposed to violence or verbal harassment from customers or patients (EU-OSHA, 2022). In the ESENER 2024 survey of workplaces, 56% of workplaces in the EU said they see "dealing with difficult customers, patients or pupils" as a risk factor (EU-OSHA, 2025).

These figures concern everyone who works with customers face to face or by phone: healthcare workers, municipal and public service staff, retail and supermarket workers, bank branches, cargo and delivery staff, hotel and restaurant workers, security guards, teachers and call centre teams.

Why Are Customer and Patient Violence Increasing?

There is no single cause of violence; individual, environmental and organisational factors come together. Some of the risk factors that stand out in Turkey today are:

• Economic pressure and tension: The high cost of living and uncertainty create a general tension in society. In situations such as a dispute over a bill, a refund request or being unable to get an appointment, this tension can easily be turned on the employee in front of them.
• Long waiting times and uncertainty: A person who does not know how long they will wait, or does not understand why their turn has been passed, gets angry faster.
• Lone working: A supermarket worker alone on the night shift, a courier making deliveries alone in the field, or the sole member of staff in a branch is more vulnerable.
• The role of delivering bad news: Refusing a request, issuing a fine, applying a deduction or giving negative health news raises tension.
• Pressure of targets and speed: If an employee is evaluated by the number of transactions per minute, they have no time left to have a calming conversation with an agitated customer.
• Social media and recording culture: Filming and sharing an employee's image without permission carries the effect of the incident beyond the workplace.

Healthcare, emergency and humanitarian workers are at particularly high risk. In the World Health Organization's 2022 guidelines on mental health at work, organisational interventions and manager training for these occupational groups appear as separate recommendations (WHO, 2022).

The Effects of Violence on Employees and Organisations

Even a single serious incident can leave a lasting mark on an employee. A more common situation, though, is small but repeated attacks: a few insults every day, a few threats every week. Over time this accumulation can lead to:

• Sleep problems, tension, intense anxiety before going to work
• Avoiding certain types of customers or certain times
• Replaying the incident in the mind, being jumpy, being on guard
• Emotional exhaustion, distancing from customers and cynicism
• Sick leave, coming to work but being unproductive (presenteeism) and leaving the job

After a serious assault, some employees may develop post-traumatic stress symptoms. I describe how these symptoms progress in detail in the article on post-traumatic stress disorder. Of course, not every difficulty means a disorder; but if symptoms continue for weeks, professional assessment is needed.

It is not only the employee who was attacked who is affected. Colleagues who witnessed the incident, those who will work at the same counter the next day and team members who hear about it afterwards may experience similar unease. Especially when the management says nothing after the incident, a feeling takes hold in the team that "no one protects us here". This feeling quietly erodes commitment and trust in the organisation.

For the organisation, the consequences show up in service quality. An employee who is afraid or exhausted has less patience with customers, is more likely to make mistakes, and experienced staff are lost. Moreover, in an environment where violence is seen as "normal", employees stop reporting incidents; management therefore cannot see the real size of the risk.

Calling customer violence "part of the job" is the shortest way of telling an employee that they are alone.

The Employer's Legal Responsibility for Workplace Violence

In Turkey there is no single workplace provision that regulates customer violence by name, but the existing legislation places a clear duty of protection on the employer.

• Occupational Health and Safety Law No. 6331, Art. 4: The employer is obliged to ensure employees' work-related health and safety, and carries out or commissions a risk assessment.
• Law No. 6331, Art. 5/f: The employer develops a coherent prevention policy covering the effects of factors related to work organisation, social relationships and the working environment. Interaction with customers is part of this "social relationships" and "work organisation" dimension.
• Regulation on Risk Assessment (Risk Değerlendirmesi Yönetmeliği), Art. 8: Psychosocial sources of hazard in the working environment must also be identified and recorded. Customer and patient violence is a psychosocial hazard that should be included in the risk assessment.
• Turkish Code of Obligations (Türk Borçlar Kanunu) No. 6098, Art. 417: The employer is obliged to take all measures necessary to protect the employee's personality and for occupational health and safety.

In the international framework, the ILO's Violence and Harassment Convention No. 190 (2019) also covers violence coming from third parties. According to statements from ILO Ankara, Turkey has not yet ratified this convention; even so, the convention is a guiding resource for good practice. For legal details, I recommend taking the opinion of your organisation's legal adviser.

Concrete Steps Employers Can Take

The most effective approach to combating violence is to build organisational measures together with individual support, rather than leaving each incident to the individual employee's "coping skills". The ILO likewise stresses that individual measures should complement organisational measures, not replace them (ILO, 2026).

1. Make the risk visible

• Treat customer and patient violence as a separate heading in the risk assessment.
• Identify in which unit, at what times and in what types of transaction tension rises.
• Record verbal attacks too; counting only physical incidents shows an incomplete picture.

2. Adjust the environment and processes

• Make waiting times visible and make the queuing system clear.
• Reduce lone working as far as possible; if you cannot, provide regular check-ins and a way to call for help quickly.
• Plan the layout of counters and desks so as to leave the employee an area to step back into.
• Handle transactions with a high likelihood of escalating tension (refusals, fines, bad news) together with experienced staff or a manager.

3. Write a clear policy

The policy text should say plainly that the organisation's "the customer is always right" approach does not extend to violence. It should include:

• A definition of behaviours that will not be accepted (insults, threats, physical contact, unauthorised recording)
• The employee's right to end the interaction and call for help
• The reporting channel after an incident and the manager's responsibilities
• Cooperation with the security unit and law enforcement in serious incidents

4. Train employees and managers

Frontline staff can be taught de-escalation skills: a calm tone of voice, naming the other person's emotion, offering options, setting boundaries and knowing when to step back. For managers, it is critical to learn how to talk to an employee after an incident. In the WHO guidelines, mental health training for managers appears as the recommendation with the strongest evidence (WHO, 2022).

5. Set up an after-incident support protocol

What to do after a serious incident should be clear beforehand:

• Ensure the employee's safety, get medical help if needed; if there is immediate danger, call 112 (emergency services).
• Do not send the employee straight back to the same work; provide a short break and a quiet space.
• Apply the principles of psychological first aid: Look, Listen, Link. That is, observe the person's needs, listen without pressure and connect them to sources of practical and social support (WHO, 2011).
• Do not hold group "psychological debriefing" sessions in which everyone has to recount the incident one by one; the WHO does not recommend this practice (WHO mhGAP).
• Check in with the employee regularly over the following weeks; refer them to professional support if symptoms continue.

I describe a similar approach for workplace accidents in the article on psychological support after a workplace accident; the principles are largely shared.

6. Make reporting safe

If employees meet a reaction like "you should have been more patient" when they report violence, they will not report again. Make reporting easy, quick and free of blame; follow up on every report.

7. Do not forget violence on digital channels

Today a significant part of customer violence does not come face to face, but through the phone, email, messaging apps and social media. Swearing directed at a call centre agent, negative posts made using an employee's name or threatening messages sent to their personal accounts should be handled with the same seriousness. Rules for keeping records, ending the interaction and passing it to a manager should be set for these channels too. Not sharing employees' personal phone numbers and social media accounts with customers, using corporate accounts, and the organisation supporting the removal of footage taken without permission make the employee feel protected.

How to Start in Your Organisation

Say you manage a retail chain with several branches and you hear that incidents of cashiers being insulted have been rising in recent months. Instead of scattered measures, this three-stage path can be followed:

Needs analysis: Existing incident records are reviewed, and short surveys and focus group discussions are held with employees. Questions are answered such as: in which branch, at what time and in which transaction is the risk concentrated, and how do employees feel after an incident and what do they need? This analysis can also be carried out as part of a psychosocial risk assessment; for details see the corporate analysis section.

Programme: Based on the analysis results, a policy text is prepared, de-escalation training is given to frontline staff, and post-incident conversation and psychological first aid training to managers. Referral and individual support routes are set for serious incidents. A structure that includes reinforcement sessions should be preferred to a one-off seminar. You can find the general framework of such programmes on the corporate services page.

Measurement: Incident report numbers (an initial rise may be a sign that reporting has become safe), post-incident sick leave, resignations, use of support services and employee surveys are monitored regularly. The ILO likewise recommends absenteeism, resignations, violence and harassment reports, use of support services and employee surveys as monitoring indicators (ILO, 2026).

Frequently Asked Questions

Does verbal abuse count as workplace violence too?

Yes. Insults, shouting, humiliation and threats are forms of psychological violence. According to ILO data, psychological violence is the most common type of violence encountered in working life. Recording and prevention systems should therefore not be limited to physical incidents.

Can an employee end the interaction with an aggressive customer?

The organisation's policy should define this clearly. Giving the employee the right to end the interaction in the face of certain behaviours, call a manager and ask for security support is important both for the employee's safety and so that the incident does not escalate.

Should we hold a review meeting with the whole team after an incident?

An operational briefing (what happened, what measures will be taken) can be held. However, group sessions that force everyone to describe their feelings and the incident in detail are not recommended by the WHO. Instead, psychological first aid, follow-up and, where necessary, individual support should be preferred.

When should an employee who has experienced violence be referred to professional support?

Tension, sleep problems or being on guard in the first days after an incident ease over time in many people. If symptoms continue for several weeks, make it hard to come to work or keep getting worse, it is appropriate to get an assessment from a mental health professional. In emergencies such as thoughts of harming oneself or others, 112 (emergency services) should be called.

• #workplace violence
• #customer violence
• #healthcare workers
• #psychosocial risk

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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