The number of reported assaults against NHS staff has increased by 8 per cent from 63,199 in 2012/13 to 68,683 in 2013/14. The majority of these – 69% – occurred in mental health or learning disability settings.
Violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security.
This updated guideline on the management of violent and aggressive behaviour in people with mental health problems covers the short-term management of violence and physically threatening behaviour in psychiatric settings, emergency and urgent care services, assertive community teams, community mental health teams and primary care.
Physical restraint as the last resort
The guideline recommends that physical restraint should only be used as a last resort, once all other methods of preventing or calming the situation have failed. However, if restraint is the only course of action available, the guideline includes clear recommendations on how it should be done to ensure the safety of both staff and the individual.
Other recommendations include offering staff training so that they have the skills to defuse a potentially violent or aggressive situation. Staff training in de-escalation should enable staff to recognise the early signs of agitation, irritation, anger and aggression, use techniques for distraction and calming, and ways to encourage relaxation.
The guideline also makes recommendations on what to do if children and young people become aggressive or violent.
Professor Mark Baker, NICE Centre for Clinical Practice director, said: “This newly updated guideline is designed to help prevent violent situations and to manage them safely when they do occur. New information on anticipating and reducing risk, as well as ways to calm people down has been incorporated and we have also listened to the views of service users on physical restraint and isolation.
“The guideline focuses on how to assess risk and prevent violence, including how to recognise warning signs, to calm potentially violent patients and manage difficult situations as well as to intervene safely when violence happens.”
Professor Peter Tyrer, from Imperial College London and chair of the group that developed the guideline, said: “We have many programmes in the country that concentrate on dealing with actual violence but not enough on preventing and de-escalating violence when it is beginning to emerge. Greater understanding of the suffering that leads to violence is an essential part of management.”
“A major step forward for people with mental health problems”
Professor Tim Kendall, Director of the National Collaborating Centre for Mental Health, who was also involved in developing the guideline, added: “We now want to see a culture of tolerance towards people with mental health problems, helping health and social care professionals to de-escalate difficult situations and help service users get the support they need when circumstances in the health service can make things worse.
“We want to reduce the times when we restrict people who are wound up by mental health problems and placed in restrictive environments. We are recommending that every trust has a restrictive interventions reduction programme. We also want to develop a culture of learning, such that service users and professionals together can review every time we restrain or restrict a person’s freedom; and give as much attention to human rights as we do to safety.
“This guidance represents a major step forward for people with mental health problems, especially in institutional settings, but also in the community and across health and social care.”