De-escalation: the evidence, policy and practice
| Pages | 100-108 |
| Date | 09 September 2013 |
| DOI | https://doi.org/10.1108/JIDOB-01-2013-0001 |
| Published date | 09 September 2013 |
| Author | Pamela Inglis,Andrew Clifton |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour |
De-escalation: the evidence, policy and
practice
Pamela Inglis and Andrew Clifton
Dr Pamela Inglis is a Director of
Programmes, based at Faculty
of Health and Life Sciences,
Northumbria University,
Northumbria, UK.
Dr Andrew Clifton is a Senior
Lecturer Mental Health
Nursing, based at School of
Health and Human Sciences,
University of Huddersfield,
Huddersfield, UK.
Abstract
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 – Thepaper 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-escalationpolicy 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.
Keywords Policy, Learning disability, Forensic, De-escalation
Paper type Viewpoint
Background
This paper deals mainly with the topic of violence, aggression and de-escalation. First, it defines
de-escalation and describes the techniques commonly used. The evidence base for the
techniques will be questioned throughout. Aggression at work is defined as:
[y] any work-related action that includes the deliberate use of physical strength or emotional harm
(Drach-Zahavy et al., 2012, pp. 43 and 44).
This suggests that aggression may be physical and/or verbal. The incidence of aggression and
threats directedagainst staff has been increasingwithin the field of health and social care(Dalton
and Eracleous, 2006). Studies into the abuse of professionals have emphasised the stressful
effects of even non-physical violence upon staff and arguably more importantly, the relationships
which are essential for effective nursing care (Scott, 2008; Dalton and Eracleous, 2006).
Verbal aggression consists of attacking a person’s self-concept and or their position on a topic
and as such is an obvious barrier to any therapeutic intervention. Additionally, there is evidence
to suggest that impulsive aggression begins with threats and abuse, this may then escalate
into a physical attack – therefore the importance of deescalating violence at the level of verbal
aggression is paramount (Jeffery and Austin, 2005; McKenzie and Cur, 2005).
PAGE 100
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 4 NO. 3/4 2013, pp. 100-108, CEmerald Group Publishing Limited, ISSN 20 50-8824 DOI 10.1108/JIDOB-01-2013-0001
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