Early intervention strategies for de-escalation

What early intervention strategies can de-escalate violence?

While many patients express anger, it usually resolves with respectful communication and very few patients react violently. Patients can sometimes become aggressive because they don’t understand the ‘system’ or why they can’t get what they want. Often, understanding this and explaining makes a difference.

If you believe you are not in immediate danger, you may try to de-escalate the situation by:

• appearing calm and remaining respectful, controlled and confident
• using reflective questioning – demonstrate that you are listening by confirming the message is right (eg ‘You need to a see a GP as soon as possible, is that correct?’)
• being clear and direct in your language, and clearly and simply explaining your intentions – complex questions or concepts may increase anxiety
• monitoring your body language and avoiding acts like crossing your arms and intense eye contact – these can be perceived as threatening  
• assuring the patient your actions are in their best interest
• engaging the patient by asking questions that are likely to elicit a ‘yes’. The most effective way is to briefly summarise the patient’s perceptions and views as you understand them, with questions at the end such as ‘Have I got that right?’ or ‘Is that what you mean?’ A sequence of five or six questions where the patient is answering ‘yes’ is a powerful way to increase the likelihood that that an aggressive patient will see you as being on their side, even if they remain angry about the issue  maintaining a solution focus – ask the patient to solve the problem they are concerned about by identifying as many solutions as they can think of to address the problem. Repeat these back to them rather than arguing about the pros and cons of each option. This may lead to compromise between parties and avoid a ‘black and white’ or ‘us and them’ situation.