De-Escalation Techniques in Psychiatry

Mental health issues or the impact of stress factors often manifest themselves in aggressive behavior (both verbal and physical aggression), touchiness, and increased communication needs. The ability to reduce unwanted behaviors remains extremely important when it comes to psychiatric settings. There is a range of recommended de-escalation techniques that help patients to deal with their negative emotions and, therefore, prevent provider-patient conflicts. Importantly, the choice of methods to manage clients’ concerns should depend on specific circumstances and symptoms.

There is a wide range of practices that help to encourage de-escalation. As for the definition of the process, it involves managing unwanted behavior in other people, usually patients. Therefore, de-escalation techniques are used in order to improve treatment outcomes and provide patients with support to encourage further self-help. In addition, by implementing proper de-escalation practices and analyzing the response, health professionals can single out socially dangerous individuals.

The video posted by Crisis Prevention Institute (2010) illustrates numerous de-escalation techniques that can be used in both educational and professional settings. The majority of de-escalation techniques included in the video relate to proper non-verbal behavior. In particular, during de-escalation, it is pivotal to respect an individual’s need for personal space to avoid defensive behavior (Crisis Prevention Institute, 2010). Even though violating other people’s private space should be avoided, touching a patient can sometimes be helpful, as is clear from the educational video; however, the level of trust should be taken into account prior to using this practice.

Apart from the use of non-verbal communication, popular de-escalation techniques involve engaging patients in various activities in order to change their focus of attention. Thus, common techniques that are recommended to health professionals include offering food or drinks, decreasing patient clinic waiting time, and preventing the causes of sensory overload by reducing noise or other stress factors (Townsend & Morgan, 2018). Moreover, in order to encourage de-escalation, health professionals are expected to distract their patients from concerns and problems. To fulfill this goal, it is possible to take the physical condition of a patient into account and offer him or her to wait in a more quiet room or solve an interesting issue.

Continuing on the topic of conflict prevention, it is pivotal to mention that de-escalation techniques can sometimes be ineffective. The first thing that any healthcare specialist should consider is the timeliness of de-escalation. Understanding that healthcare providers are not ready to support them, many patients become more anxious, and their covert aggression can loom large to pose a threat to other people’s safety. De-escalation techniques can also be ineffective for patients with severe mental illnesses who are unable to recognize their interlocutors’ communicative goals. In such cases, physiological regulating medications and seclusion are often used to reduce threats (Kuivalainen et al., 2017). Patient expectations also play a significant role in the effectiveness of de-escalation techniques. Recent research indicates that many patients in mental healthcare settings are concerned about their safety when it comes to de-escalation (Oyelade, Smith, & Jarvis, 2017). Therefore, to avoid anxiety, it is necessary to increase awareness of cases in which coercive practices are used.

In the end, modern researchers who design practices helping to manage unwanted behavior and prevent conflicts also pay close attention to the impact of proper socialization in de-escalation. Other common techniques that reduce patient anxiety in an effective way are based on the premise that active group participation boosts creativity and helps people to become more goal-oriented. In this connection, strengthening links between patients who may have similar problems acts as an important de-escalation technique.

References

Townsend, M. C., & Morgan, K. I. (2018). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). Philadelphia, PA: F. A. Davis Company.

Oyelade, O., Smith, A. A. H., & Jarvis, M. A. (2017). Dismissing de-escalation techniques as an intervention to manage verbal aggression within mental health care settings: Attitudes of psychiatric hospital-based Nigerian mental health nurses. African Journal of Nursing and Midwifery, 19(2), 1-18.

Kuivalainen, S., Vehviläinen-Julkunen, K., Louheranta, O., Putkonen, A., Repo-Tiihonen, E., & Tiihonen, J. (2017). De-escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital. International Journal of Mental Health Nursing, 26(5), 513-524.

Crisis Prevention Institute. (2010). De escalation techniques [Video file]. Web.