Managing violence and aggression

Warning

If you are dealing with a patient who is exhibiting violence or aggression please refer to your local guidelines. Below are some general principles: 

1. Consider safety first:

  • Always involve other members of your MDT. Particularly those who are trained in patient restraint. 
  • If you're not in a mental health hospital you may need to phone security.

2. If it is safe to do so, attempt verbal de-escalation 

  • Use calm, non threatening body language
  • Express empathy
  • Can you identify a trigger for this patient's behaviour?

3. Consider using sedative medications such as:

  • First line: benzodiazepines
  • Second line: antipsychotics - use with caution
  • Use much smaller doses in elderly or frail patients 
  • REFER TO LOCAL GUIDELINES AND CONSIDER DISCUSSING WITH A SENIOR

4. Consider the legal implications. Do you think the patient might require: 

  • detention under the mental health act?
  • adults with incapacity form?

For more information, please follow the link in Resources below, which will take you the the NICE Guidelines for managing violence and aggression in patients with mental illness.

Last reviewed: 21/02/2024

Next review date: 21/08/2024

Author(s): Medical Education Fellow, NHS Lothian.

Author email(s): mypsych@ggc.scot.nhs.uk.

Reviewer name(s): Medical Education Fellow, NHS Lothian.