Management Imminent Violence

Risk assessment

All staff should be trained to recognise the warning signs of violence and to monitor their own verbal and non-verbal behaviour.

Possible antecedents of violence:

• Increased restlessness, bodily tension, pacing, arousal
• Refusal to communicate, withdrawal
• Verbal threats or gestures
• Increased volume of speech, erratic movements
• Thought processes unclear, poor concentration
• Self-reporting angry or violent feelings
• Facial expression tense and angry, discontented
• Delusions or hallucinations with violent content
• Carers reporting users’ imminent violence

Tactics for de-escalation

• Maintain adequate distance
• Move towards safe place, avoid corners
• Explain intentions to patient and others
• Appear calm, self-controlled, confident
• Ensure own non-verbal communication is non-threatening
• Engage in conversation, acknowledge concerns and feelings
• Ask for facts of problems, encourage reasoning
• Ask for weapon to be put down (not handed over)
• Consider methods (e.g. medication)

Restraint

Restraint should be used only after the failure of attempts to promote full participation in self care, e.g. by voluntary 'time out' and/or consent to take medication. It should not be used as a means of intimidation or punishment but only as a last resort, at the end of a hierarchy of interventions. If restraint is necessary, it should be used with thoughtful consideration for the self-respect, dignity, privacy, cultural values, and any special needs (e.g. physical illness or disability) that the patient may have. Mechanical restraints should not be used.

• Staff must receive training in the use of restraint
• The reasons for restraint should be explained to the patient
• Team members should be allocated responsibilities
• Miantain communication
• Be appropriate to the age, size and gender of the patient (not be dependent on the height or weight of staff members or patient)
• Not involve neck compression
• Use secure grips, Minimise pain, Maintain dignity
• Protect the patient's head during descent
• Protect the patient's air supply and use controlled descents
• Avoid unnecessary pressure on the patient's back or chest