Enhancing de-escalation in mental health (EDITION study), WP3
Research type
Research Study
Full title
Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION), WP3
IRAS ID
265168
Contact name
Owen Price
Contact email
Sponsor organisation
University of Manchester
ISRCTN Number
ISRCTN12826685
Duration of Study in the UK
0 years, 7 months, 29 days
Research summary
Research Summary
De-escalation techniques are recommended for averting potential violence in mental health settings without resorting to restrictive practices such as restraint or seclusion. However existing training is non-evidence-based and restrictive practices are used too often/too soon in response to disturbed behaviour.
Our aim is to develop a de-escalation staff training package to reduce rates of conflict and use of restrictive practices in adult acute and forensic in-patient mental health settings. This is being funded through the NIHR Health Technology Assessment program, which funds research about the clinical and cost effectiveness and broader impact of healthcare treatments.
This is being done through three distinct work packages; this application relates solely to work package three.
In work package one we updated our summary of the existing scientific evidence on the key components of effective de-escalation practice and training as well as conducting interview and focus groups on mental health wards. This was to explore different perspectives on what is necessary for successful de-escalation, as well as the barriers to it occurring.In work package two we then used this evidence to develop a set of intervention targets. Through a series of stakeholder events (involving staff, academics, service users, carers and trainers) we condensed and structured these targets to develop a draft of the EDITION training intervention.
Work package 3 will deliver this training intervention to staff from ten wards in two different NHS trusts (including male and female, acute, PICU, low, medium and high secure.) Staff and patient participants will be recruited from these wards and we will conduct interviews and observations with them to see if the training intervention is seen as acceptable, as well as questionnaires to look at different outcomes (including attitudes to containment, attitudes to personality disorder and levels of conflict and restrictive practice) before and after the training was delivered.
Summary of Results
Mental health hospitals are stressful places for patients and staff. Patients are often detained against their will, in places that are noisy, unfamiliar, and frightening. Violence and self-injury happen quite frequently. Sometimes staff physically restrain patients or isolate patients in locked rooms (called seclusion). Whilst these measures might sometimes be necessary to maintain safety, they are psychologically and physically harmful. To help reduce the use of these unsafe measures, staff are trained in communication skills designed to reduce anger and distress without using physical force. Professionals call these skills ‘de-escalation.’ Although training in de-escalation is mandatory, there is no good evidence to say whether it works or not, or what specific techniques staff should be trained in. The EDITION project aimed to develop and evaluate a de-escalation training programme informed by research evidence. We interviewed over one hundred people who either currently worked in or received treatment in a mental health hospital. These people were clear that the training should target key sources of interpersonal and environmental stress that prevent de-escalation from working. We also reviewed all the scientific studies on de-escalation and training, aiming to identify the elements of training that are most likely to increase use of de-escalation. Then, in partnership with current mental health service users and clinical staff, we developed the training programme. Training was delivered to more than 270 staff working in ten different wards in mental health hospitals. We measured rates of violence, self-injury and use of physical restraint and seclusion eight weeks before staff received training and 16 weeks after they received training (24 weeks of data collection in total). Analysis of these data showed that these unsafe events were occurring significantly less frequently after training than they were before training, which raised the possibility that the training was helping to reduce harm.
REC name
West of Scotland REC 1
REC reference
19/WS/0098
Date of REC Opinion
19 Aug 2019
REC opinion
Further Information Favourable Opinion