Before disruptive behavior turns to chaos, professionals with the necessary skills to de-escalate situations can help prevent catastrophes by learning to address aggression before it escalates.

 

Stan is a client with a history of aggression.

Today, he’s been agitated since lunch, and now he just got cut off during group therapy because a staff member interrupted group with a new client’s arrival.

He then cuts off the staff member saying, “Yo, I was talking.  Don’t be an asshole.”

The staff member says, “​I apologize for interrupting but let’s welcome John to the group and be respectful.”​

The next thing everyone knows, Stan is tearing up the day room.

He’s breaking furniture and turning over chairs. He barrels down the hall into the acute unit, jumps over the nurses’ station, and starts stuffing charts in the garbage.

By the time you’re called to the scene, Mike’s in a corner, wielding a chair.

He looks like he could come at you with it.

But you know how to prevent that.

What you say is simple.

And you know it’s going to work because of HOW you say it.

Calmly—not showing panic that would contribute to the chaos—you say, “Hey Stan, how can I help?”

Stan likes you because you have a good rapport with him. He likes your tone.

He tells you he wants a to be heard in group. You know you can’t make that happen right now, so you say, “What else do you want, Stan?”

Stan says he just wants to go lie down.

Another staff member says, “​No sleeping allowed midday! You’​ll sleep at night.”​

You see how this escalates Stan as he wields the chair higher. You signal for the staff to back away, and you say, “I can make a nap possible for you.”

You see how this calms Stan, so you say in a respectful tone, “But you can’t throw things.”

Stan lowers the chair very slightly, and you can see that his anger is starting to deflate. He’s almost done exploding. And your demeanor has calmed him. 

So you say, “Will you put the chair down?”

And Stan puts the chair down.

Because of you, the standoff is over.

Staff can’t believe your magic touch.

But it’s not magic.

It’s know-how. It’s knowing what escalates Stan, and what calms him. It’s knowing which rules are negotiable and which are not. It’s knowing how to assess risk, and which intervention to use and when.

 

Handled differently, this situation could have led to a physical struggle. The chair might have gotten thrown. Team restraint might have been necessary. Injuries and pain might have resulted. 

But the de-escalation skills used prevented an out-of-control situation from spinning more out of control.

It’s far better to prevent behavioral incidents than to be thrust into the middle to manage them. It is important to train and to plan and take action well ahead of any escalation.

INTRODUCTION:

The best time to begin responding to an impending incident is right now.  Let’s take a look at what aggressive behavior is, how to recognize the warning signs and how to respond to help before it gets out of control.

Violence in psychiatric settings is a complex workplace problem. Frequent serious incidents have been reported in studies. In one study, 60 percent of psychiatric staff who had experienced violence felt that help was not readily available, 42 percent were dissatisfied with procedures after the incident, and 43 percent felt their work environment to be unsafe.

Managing aggressive and violent behavior has become an essential skill pertinent to all staff providing behavioral services. What was once a skill reserved for those who worked on locked psychiatric units, now is in demand for emergency room staff, outpatient counselors, educators, and security and law enforcement personnel. The need for safe, effective techniques to manage the potentially assaultive person is no longer limited to those who work with individuals who are mentally ill. The clerical admissions worker feels the same fear in today’s human service setting as does the security officer.  Now more than ever learning to de-escalate a potentially violent situation through words is a very important skill.  The country is looking to mental health professionals to intervene in numerous situations even potentially in law enforcement to end devastating outcomes.

Yet, many human service providers do not have the technical skills necessary to manage violent behavior. This lack of skill and training produces normal reactions of fear and self-protection when confronted with violence. If one does not have the necessary skills to manage violence, he naturally reverts to instinctive responses. The challenge of managing violence in today’s workplace can be met only by a commitment from administration to firmly confront the problem with quality training on an ongoing basis. Human service providers need safe, effective behavior management training designed to maintain the Care, Welfare, Safety, and Security of all involved in the intervention process.

Aggression Control is a safe, non harmful behavior management designed to aid human service professionals in the management of disruptive and assaultive people, even during the most violent moments.

To help predict aggressive and violent behaviors, the frequency and types of these behaviors have been examined through various methods and studies. Through these methods complex relationships between staffing, patient mix, and violence were found. In general terms, across the studies, relative risk increased with more nursing staff (of either sex), more non-nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.

Aggression in its broadest sense is behavioral, or a disposition or tendency to act in a particular manner that is either forceful, hostile or attacking (or some combination of the three). It may occur either in retaliation or without provocation. In narrower definitions that are used in social and behavioral sciences, aggression is an intention to cause harm or an act intended to increase relative social dominance. Predatory or defensive behavior between members of different species may not be considered aggression in the same sense. Aggression can take a variety of forms and can be physical or be communicated verbally or non-verbally. Aggression differs from what is commonly called assertiveness, although the terms are often used interchangeably among laypeople, e.g. an aggressive salesperson.

Ethologists study aggression as it relates to the interaction and evolution of animals in natural settings. In such settings aggression can involve bodily contact such as biting, hitting or pushing, but most conflicts are settled by threat displays and intimidating thrusts that cause no physical harm. This form of aggression may include the display of body size, antlers, claws or teeth; stereotyped signals including facial expressions; vocalizations such as bird song; the release of chemicals; and changes in coloration. The term agonistic behavior is sometimes used to refer to these forms of behavior.

Most ethologists believe that aggression confers biological advantages. Aggression may help an animal secure territory, including resources such as food and water. Aggression between males often occurs to secure mating opportunities, and results in selection of the healthier/more vigorous animal. Aggression may also occur for self-protection or to protect offspring. Aggression between groups of animals may also confer advantage; for example, hostile behavior may force a population of animals into a new territory, where the need to adapt to a new environment may lead to an increase in genetic flexibility.