FAQS On Managing The Violent Patient

Dealing with violence and aggression is an area where health professionals
often feel uncertain. Standing at the interface between medicine, psychiatry
and law, the best actions may not be clear, and guidelines neither consistently
applicable nor explicit. An aggressive, violent or abusive patient may be
behaving anti-socially or criminally. But in acute medical settings it is
more likely that a medical, mental health or emotional problem, or some
combination thereof, is the explanation and usually we will not know the relative contribution
of each element. We must assume that dif cult behaviour represents the communication
of distress or unmet need. We can prevent and de-escalate situations by understanding why
they have arisen, identifying the need, and trying to anticipate or meet it. In these situations
‘challenging behaviour’ is much like any other presenting problem: the medical approach is
to diagnose and treat, while trying to maintain safety and function. In addition, the personcentred approach of trying to understand and address psychological and emotional distress
is required. Skilled communication, non-confrontation, relationship-building and negotiation
represent the best way to manage situations and avoid harm. If an incident is becoming
dangerous, doctors need to know how to act to defuse the situation, or make it safe. Doctors
must know about de-escalation and non-drug approaches, but also be con dent about when
physical restraint and drug treatment are necessary, and how to go about using appropriate
drugs, doses, monitoring and aftercare. There are necessary safeguards around using these
approaches, from the perspectives of physical health, mental wellbeing, and human rights.