People prone to aggressive and abuse behaviour are at greater risk of mental illness
Aggressive and abusive behaviour is also a feature of mental illness
40% of medical staff report being physically assaulted at some point in their career.
Assessment of Aggression
- Probability – that the risk will become reality
- Seriousness – how serious is the risk?
- Imminence – when is it likely to occur?
- Be calm yourself. Avoid hostility and aggression on your own part.
- Be sensitive to the patient’s needs
- Be clear in your communication
- Be non-confrontational
- You can manipulate the setting for consultations. You should avoid:
- Enclosed small spaces
- Noisy environments
- Places where ‘weapons’ (e.g. chairs, knives, etc) are close at hand
- Make sure other patient’s aren’t around, equally, you should remove staff who might not help the situation, and enlist the help of staff who may be able to help. Don’t overcrowd the patient, but ensure there are enough staff there for their own safety.
- During the consultation
- Listen to and acknowledge the patient’s concerns
- Encourage reasoning
- Negotiate with the patient where to progress to from here, including treatment for any mental health conditions, in necessary
- These basic techniques are called verbal de-escalation
- Respiratory or cardiac problems
- High levels of blood alcohol
- Other physical illness
- If the patient also is suffering from psychosis (including delusion,s hallucinations, mania, and other symptoms f schizophrenia) , then an antipsychotic is usually also given.
- Be careful, and follow BNF guidelines closely.
- Oral administration is preferable, but in certain situations (often very aggressive patients will not be complaint with oral medications), you may have to give the drugs IM, IV or as rectal preparations.
- Ensure one team member is in charge of the procedure
- Ensure the head neck and airway are always closely monitored
- You may require one staff member to restrain each limb
- Restraint may be required to administer drug interventions (described above)
- Restraint should be avoided in the elderly, are those who are likely to be injured (e.g. osteoporosis)
- There are roughly 500 homicides in the UK each year. The rise and fall of this figure correlates with research about the levels of aggression within the general population.
- 10% of these (i.e. about 50) are committed by an individual who is suffering from a mental illness at the time. At the time of the offence, these people were usually not in contact with mental health services.
- 30% of all homicides are committed by somebody with any previous history of mental illness
- Alcohol and drug misuse are implicated in 7% of homicides
- Assaults are massively more common