Patient perspectives on barriers and enablers to the use and effectiveness of de‐escalation techniques for the management of violence and aggression in mental health settings

Aim: Investigate patient perspectives on barriers and enablers to the use and effectiveness of de‐escalation techniques for aggression in mental health settings. Background: De‐escalation techniques are the recommended first‐line intervention for the management of aggression in mental health settings internationally, yet use of higher risk restrictive practices persists. This indicates de‐escalation techniques are not used at optimum frequency and/or there are important factors limiting their use and effect. Design: Descriptive qualitative research using semi‐structured interviews and Framework Analysis. Methods: Inpatient interviews (N = 26) exploring staff, patient and environmental factors influencing the use and effectiveness of staff de‐escalation were conducted mid‐2014. Three service user researchers led analysis. Results: Data were synthesized in three deductive themes relating to staff, patient and environmental influences on the use and effectiveness of de‐escalation techniques. The dominant view was that restrictive practices, rather than de‐escalation techniques, are used in response to escalating patient behaviour. Under‐use of de‐escalation techniques was attributed to: lack of staff reflection on culture and practice and a need to retain control/dominance over patients. Ward rules, patient factors and a lack of staff respect for patients diluted their effectiveness. Participants identified a systematic process of de‐escalation, rule subversion, reduced social distance and staff authenticity as enablers of effective de‐escalation. Conclusion: This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de‐escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de‐escalation techniques.