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Chapter 14 - De-escalation

Published online by Cambridge University Press:  15 March 2024

By
Roland Dix  and
Mathew Page
Edited by
Roland Dix ,
Stephen Dye  and
Stephen M. Pereira
Roland Dix
Affiliation:
Gloucestershire Health and Care NHS Foundation Trust, Gloucester
Stephen Dye
Affiliation:
Norfolk and Suffolk Foundation Trust, Ipswich
Stephen M. Pereira
Affiliation:
Keats House, London
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Summary

De-escalation is a term that is often used by psychiatric professionals yet if they asked for a definition of it, there would be differing responses. This chapter outlines not only a definition but the essential elements within its practice and how de-escalation fits into the spectrum of management of challenging and disturbed behaviour.

Keywords

de-escalationchallenging behaviourdisturbed behaviourpsychiatry
Type
Chapter
Information
Psychiatric Intensive Care , pp. 178 - 186
Publisher: Cambridge University Press
Print publication year: 2024

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References

Bensley, L, Nelson, N, Kaufman, J, Silverstein, B and Shield, J (1995) Patient and Staff Views of Factors Influencing Assaults on Psychiatric Hospital Employees. Issues in Mental Health Nursing 16 (5) 433–46.CrossRefGoogle ScholarPubMed
Berne, E (1964) Games People Play: The Psychology of Human Relationships. Harmondsworth: Penguin.Google Scholar
Betempts, E, Somoza, E and Buncher, C (1993) Hospital Characteristics, Diagnoses, and Staff Reasons Associated with the Use of Seclusion and Restraint. Hospital and Community Psychiatry 44 (4) 367–71.Google Scholar
Blair, D (1991) Assaultive Behaviour: Does Provocation Begin in the Front Office?. Journal of Psychosocial Nursing and Mental Health Services 29 (5) 21–6.CrossRefGoogle ScholarPubMed
Boettcher, E (1983) Preventing Violent Behaviour: An Integrated Theoretical Model for Nursing. Perspectives in Psychiatric Care 21 (2) 54–8.Google ScholarPubMed
Cheung, P, Schweitzer, I, Tuckwell, V and Crowley, K (1997) A Prospective Study of Assaults on Staff by Psychiatric In-Patients. Medicine, Science and the Law 37 (1) 46–52.CrossRefGoogle ScholarPubMed
Davis, S (1991) Violence by Psychiatric In-Patients: A Review. Hospital and Community Psychiatry 42 (6) 585–9.Google Scholar
Davis, W (1989) The Prevention of Assault on Professional Helpers. In Howells, K and Hollin, C (eds.), Clinical Approaches to Violence. Chichester: Wiley. pp. 311–28.Google Scholar
Department of Health (2015) The Mental Health Act 1983. London: Department of Health. www.gov.uk/government/publications/code-of-practice-mental-health-act–1983.Google Scholar
Farrell, G and Gray, C (1992) Aggression: A Nurse’s Guide to Therapeutic Management. London: Scutari Press.Google Scholar
Frude, N (1989) The Physical Abuse of Children. In Howells, K and Hollin, C (eds.), Clinical Approaches to Violence. Chichester: Wiley. pp. 155–81.Google Scholar
Johnston, I, Price, O, McPherson, P, Armitage, CJ, Brooks, H, Bee, P, et al. (2022) De-escalation of Conflict in Forensic Mental Health Inpatient Settings: A Theoretical Domains Framework-Informed Qualitative Investigation of Staff and Patient Perspectives. BMC Psychology 10 (1) 30.CrossRefGoogle ScholarPubMed
Kaplan, S and Wheeler, E (1983) Survival Skills for Working With Potentially Violent Clients. Social Casework 64 (6) 339–46.CrossRefGoogle ScholarPubMed
Karpman, SB (2011) Fairy Tales and Script Drama Analysis. Group Facilitation (11) 49–52.Google Scholar
Lanza, M (1988) Factors Relevant to Patient Assault. Issues in Mental Health Nursing 9 (3) 259–70.CrossRefGoogle ScholarPubMed
Lanza, M and Campbell, R (1991) Patient Assault: A Comparison of Reporting Measures. Quality Assurance 5 (4) 60–8.Google Scholar
Lazan, M (2016) Changing Mindset to Improve Results. Industrial and Commercial Training 48 (5) 231–3.CrossRefGoogle Scholar
Le Poole, S (1987) Never Take No for an Answer: A Guide to Successful Negotiation. London: Kogan Page.Google Scholar
Maier, G (1996) Managing Threatening Behaviour. The Role of Talk Down and Talk Up. Journal of Psychosocial Nursing 34 (6) 25–30.Google ScholarPubMed
McHugh, I and West, M (1995) Handle With Care. Nursing Times 91 (6) 62–3.Google ScholarPubMed
Nyberg-Coles, M (2005) Promoting Safer and Therapeutic Services. Mental Health Practice 8 (7) 16–17.CrossRefGoogle Scholar
Patel, MX, Sethi, FN, Barnes, TRE, Dix, R, Dractu, L, Fox, B, et al. (2018) Joint BAP NAPICU Evidence-Based Consensus Guidelines for the Clinical Management of Acute Disturbance: De-escalation and Rapid Tranquillisation. Journal of Psychopharmacology 32 (6) 601–40.CrossRefGoogle ScholarPubMed
Pelto-Piri, V, Warg, LE and Kjellin, L (2020) Violence and Aggression in Psychiatric In-Patient Care in Sweden: A Critical Incident Technique Analysis of Staff Descriptions. BMC Health Services Research 20 (1) 362.CrossRefGoogle Scholar
Poyner, B and Warne, C (1986) Violence to Staff: A Basis for Assessment and Intervention. London: HMSO.Google Scholar
Price, O, Baker, J, Bee, P and Lovell, K (2018) The Support-Control Continuum: An Investigation of Staff Perspectives on Factors Influencing the Success or Failure of De-escalation Techniques for the Management of Violence and Aggression in Mental Health Settings. International Journal of Nursing Studies 77: 197–206.CrossRefGoogle ScholarPubMed
Stevenson, S (1991) Heading Off Violence with Verbal De-escalation. Journal of Psychosocial Nursing and Mental Health Services 29 (9) 6–10.CrossRefGoogle ScholarPubMed
Substance Abuse and Mental Health Services Administration (SAMHSA) (2014) SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf.Google Scholar
Turnbull, J Aiken, I, Black, L and Patterson, B (1990) Turn it Around Short-Term Management for Aggression and Anger. Journal of Psychosocial Nursing 28 (6) 7–10.Google ScholarPubMed
Ward-Stockham, K, Kapp, S, Jarden, R, Gerdtz, M and Daniel, C (2022) Effect of Safewards on Reducing Conflict and Containment and the Experiences of Staff and Consumers: A Mixed-Methods Systematic Review. International Journal of Mental Health Nursing 31 (1) 199–221.CrossRefGoogle ScholarPubMed
Webster, CD, Douglas, KS, Eaves, D and Hart, SD (1997) HCR-20 Assessing Risk of Violence, Version 2. Burnaby: Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia.Google Scholar
Whittington, R and Patterson, P (1996) Verbal and Non-Verbal Behaviour Immediately Prior to Aggression by Mentally Disordered People: Enhancing Assessment of Risk. Journal of Psychiatric and Mental Health Nursing 3 (1) 47–54.CrossRefGoogle ScholarPubMed
Wilson, A, Hurley, J, Hutchinson, M and Lakeman, R (2021) ‘Can Mental Health Nurses Working in Acute Mental Health Units Really Be Trauma-Informed ?’ An Integrative Review of the Literature. Journal of Psychiatric and Mental Health Nursing 28 (5) 900–23.CrossRefGoogle ScholarPubMed

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