An audit of the use of breakaway techniques in a large psychiatric hospital: A replication study

Accessible summary Breakaway techniques are a set of physical skills which are intended to help someone 'break away' from an aggressor. They are taught to most people who work in mental health services in the UK because assault against staff is quite common. Considerable time and money is spent teaching breakaway techniques, and it is important people should be able to remember the skills. However, breakaway training can be quite complex and we do not know whether people are able to recall the techniques if they get assaulted. We asked people who work in a large psychiatric hospital who had received breakaway training to take part in this study and 147 people agreed to do so. One of us simulated an assault on each participant and asked them to use the techniques that they had been taught to break away from the assault. Two breakaway experts watched the simulation and judged whether the participant used the correct techniques to separate from the aggressor. Only a small minority (14%) of people used the correct procedures taught to them in order to break away from an assault. However, most people (80%) did manage to break away from the assault even if they did not use the techniques taught to them. This study provides further evidence that breakaway training may be too complex for people to recall in real-life situations. More research is needed to find out what types of training are best recalled. Techniques that most closely resemble instinctual responses may be better remembered. Abstract This paper describes an audit study of the effectiveness of breakaway training conducted in a specialist inpatient mental health hospital. Breakaway techniques comprise a set of physical skills to help separate or break away from an aggressor in a safe manner, but do not involve the use of restraint. Staff (n = 147) were assessed on their ability to break away from simulations of potentially life-threatening scenarios in a timely manner, and using the techniques taught in annual breakaway or refresher training. We found that only 14% (21/147) of participants correctly used the taught techniques to break away within 10 s. However, 80% of people were able to break away from the scenarios within 10 s but did not use the techniques taught to them. This audit reinforces questions about breakaway training raised in a previous study. It further demonstrates the need for a national curriculum for physical intervention training and development of the evidence base for the content of such training as a priority.