Reported assaults against NHS staff increased by 8% from 2012/13 to 2013/14, the majority of which (69%) occurred in mental health or learning disability settings. It is estimated that violence against staff costs the NHS at least £69 million a year in staff absence, loss of productivity and additional security.
New guidance from the National Institute for Health and Care Excellence (NICE) 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, according to the guideline, should only be used as a last resort once all methods of preventing or calming the situation have failed. It also recommends extensive staff training in defusing potentially violent or aggressive situations, as well as recommendations on how to handle violence and aggressive behaviour in children and young people.
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 Tyler, from Imperial College London and chair of the group that developed the guideline, commented: “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.”
Professor Tim Kendall, Director of the National Collaborating Centre for Mental Health, 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 who are wound up by mental health problems and placed in 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.”