Guidance issued on dealing with violent patient behaviour

A series of new guidelines have been published to help NHS staff deal with disturbed and violent behaviour in patients.

The guidance drawn up by the National Institute for Clinical Excellence (NICE) aims to help staff and assess risk and prevent violent incidents, as well as de-escalate and calm down situations and intervene safely when violence occurs.

Under the new guidelines, mental health service providers will have to ensure that they have a full risk management strategy to help reduce disturbed and violent behaviour. Staff will also have to receive training, including methods of anticipating and de-escalating violent disturbances, in order to deal with disturbed or violent patients.

The guidelines said that measures such as physical restraint, seclusion and tranquillisation should only be used as a last resort and staff who may need to use these measures should also be trained in life support techniques, such as the use of defibrillators.

The NICE guidance also states that one team member should be responsible for protecting and supporting the head and neck, where required, during physical restraint and that this member should also ensure that airway and breathing are not compromised and vital signs are monitored.

Andrew Dillon, Chief Executive of NICE and Executive Lead, said: "Managing violent behaviour is about more than drugs and restraint. This guideline contains a comprehensive set of recommendations that will help ensure the safety of service users and staff in mental health settings and emergency departments and, we hope, establish principles of best practice that will be adopted across other services as well."

The NICE guidelines aim to prevent deaths such as that of David 'Rocky' Bennett, who died after being restrained for 25 minutes, following an attack on another patient.

However, the guidelines do not include a maximum time limit on the use of physical restraint.

Richard Brook, Chief Executive of mental health charity, MIND, welcomed the new guidelines, saying that they were "desperately needed". However he added: "We are dismayed that the guidelines do not specify a maximum time limit for physical restraint. The death of Rocky Bennett in 1998, after his restraint, face down, for twenty to thirty minutes, tragically illustrated how vital such limits are. Failure to introduce a maximum time limit for restraint seriously threatens the well-being of some of the most vulnerable people in the mental health system."

(KMcA/SP)