De-escalation: The evidence, policy and practice

Purpose: The management of violence and aggression is an important aspect of any service in the NHS and has been rightly tackled as a whole organisational approach. De-escalation is one such aspect of the organisation approach relating foremost to the safety of people and as such is a central part of relational security, personal safety and the therapeutic relationship. Design/methodology/approach: The paper explores the evidence and policies around de-escalation. Findings: The paper recommends that a randomised-controlled trial be designed, comparing different de-escalation techniques to establish an evidence base for this routine practice. Research limitations/implications: The paper is limited to discussing de-escalation as an approach and the policy that directs it, and does not consider individual theories on aggression and management. It makes recommendations for policy, research and practice. Practical implications: There is a lack of high-quality evidence around de-escalation policy and principles which staff may believe is evidence-based practice because training is often mandatory. This obviously impacts upon the patient experience and aspects of safety. The paper is valuable to practitioners working in secure environments, or with offenders that may require management of violence and aggression. Originality/value: There are many policies and guidelines from the government and from professional bodies that seems to have tailored off since 2005 (Muralidharan and Fenton, 2006; UKCC, 2002). Forensic staff are constrained by such guidance which is further complicated by debates concerning care/coercion and forensic environments, some of which is alluded to here.