Verbal de-escalation and psychological intervention

Managing a patient with acute behavioural disturbance is a detailed flowchart for managing a patient with acute behavioural disturbance. Use the least restrictive intervention necessary to ensure the safety of the patient, staff and others.

Verbal de-escalation is the least invasive and, together with environmental management (adaption), is the preferred management strategy for a patient with acute behavioural disturbance. Talking to the patient with empathy helps to encourage negotiation and establish cooperation. Principles of verbal de-escalation and psychological intervention for acute behavioural disturbance outlines the principles of verbal de-escalation and psychological intervention for acute behavioural disturbance.

Verbal de-escalation should be used in all patients; it can take place cyclically throughout the steps of assessing and managing acute behavioural disturbance. Verbal de-escalation provides an opportunity to assess whether:

• there is an imminent risk of harm to self or others
• the patient has psychotic symptoms or confusion
• there are any unmet needs contributing to the behaviour
• further interventions are necessary.

Children, older people, and those with cognitive impairment are more likely to respond to early intervention with verbal de-escalation and harm mitigation (see Reducing the risk of harm in acute behavioural disturbance).

Both the physical environment and the clinician’s approach can reduce the risk of escalation and avert significant harm. The effectiveness of verbal de-escalation is specific to the individual patient and the clinician, and it may escalate the situation—be aware of your own limitations and triggers. Rotate staff and vary the environment as required throughout the de-escalation process.