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Violence and Aggression update on Implementing the May 2015 NICE Guideline

Professor Brian Littlechild, Lead for Research and CPD, Department of Nursing (Children’s, Learning Disabilities and Mental Health) and Social Work, University of Hertfordshire discussed Implementing the May 2015 NICE Guideline for Violence and Aggression at today’s conference. In his presentation Mr Brian Littlechild discussed:

  • safeguarding NHS staff from violent and aggressive patients
  • ensuring physical restraint is used as a last resort only
  • changing the focus from managing to prevention and de-escalation
  • implementing the NICE guideline in practice

Professor Brian Littlechild's full presentation is available for download at the end of this page. 

In his presentation Professor Brian Littlechild's 

Amongst other areas, the Guideline examines the consequences of violence from mental health patients on workers, clients/patients themselves, and others in their formal and informal networks, and addresses how we might   respond most positively to workers and patients/service users before, during and after such incidents…Since the publication of the previous guideline in 2005 (NICE guideline 25) there have been some important advances in our knowledge of the management of violence and aggression, including service users' views on the use of physical intervention and seclusion, and the effectiveness, acceptability and safety of drugs and their dosages for rapid tranquillisation….The previous guideline was restricted to people aged 16 and over in adult psychiatric settings and emergency departments; this update has been expanded to include some of the previously excluded populations and settings. All areas of NICE guideline 25 have been updated and this guideline replaces it in full…This guideline includes adults (aged 18 and over), children (aged 12 and under) and young people (aged 13 to 17) with a mental health problem who are currently service users within mental health, health and community settings. It also covers carers of service users with mental health problems in these settings.

“Violence and aggression in mental health settings occur most frequently in inpatient psychiatric units and most acute hospital assaults take place in emergency departments…Deaths of  8 social workers  since 1978 in community settings- with isolation a key issue in community based work- and training needing to be the same in some ways, in some ways different.”

“Violence and aggression are relatively common and serious occurrences in health and social care settings. Between 2013 and 2014 there were 68,683 assaults reported against NHS staff in England: 69% of population in mental health or learning disability settings, 27% in ambulance staff, 25% involving primary care staff and 26% involving acute hospital staff.”

“Health and social care provider organisations, including ambulance trusts, should ensure that they have up-to-date policies on the management of violence and aggression in people with mental health problems, and on lone working, in community and primary care settings, in line with this guideline.”

“Health and social care provider organisations, including ambulance trusts, should ensure that staff working in community and primary care settings are able to undertake a risk collaboration with service users known to be at risk and their carers if possible.”

“Although the NICE guideline contains recommendations on intervening before violence and aggression occur, it recognises it is not always possible to avoid violence. Therefore a graded set of interventions is needed to prevent minor violence from escalating into severe violence.”

“De-escalation and Prevention is the Priority”

“Health and social care provider organisations, including ambulance trusts, should consider training staff working in community and primary care settings in methods of avoiding violence, including anticipation, prevention, de-escalation and breakaway techniques, depending on the frequency of violence and aggression in each setting.”

“Ensure that the safety and dignity of service users and the safety of staff are priorities when anticipating or managing violence and aggression”

“Health and social care provider organisations should ensure that all services that use restrictive interventions have a restrictive intervention reduction programme (see recommendation 1.2.3) to reduce the incidence of violence and aggression and the use of restrictive interventions.”

“Use a designated area or room to reduce emotional arousal or agitation and support the service user to become calm. In services where seclusion  is practised, do not routinely use the seclusion room for this purpose because the service user may perceive this as threatening.”

“Encourage service users to recognise their own triggers and early warning signs of violence and aggression and other vulnerabilities, and to discuss and negotiate their wishes should they become agitated. Include this information in care plans and advance statements and give a copy to the service user.”

“Communicate respect for and empathy with the service user at all stages of de-escalation."

'There is a very high rate of violence & aggression in health and social care organisations'

'How can we think about using a graded system to stop violence progressing'

'We all need to know what we can learn to prevent violence & aggression'

'We must involve service users in decision making and carer's should also be involved in this - co-production', 'We need to look at everyone's views to try and diminish the effects'

'Culture change is a huge thing for any organization. We need to address the different things that can help to make the change'

Professor Brian Littlechild Biography:

Professor Brian Littlechild is   the lead for Research and CPD in the Department of Nursing (Children’s, Learning Disabilities and Mental Health) and Social Work at the University of Hertfordshire.

After working in hostels for homeless people, and as a deputy warden of an after care hostel for people leaving prison and secure psychiatric care, he worked as a nursing assistant and social worker in large psychiatric hospitals. He then worked as a social worker with children and their families, young offenders, and as an Approved Social Worker under the Mental Health Act 1983 before working in universities.

He has carried out 21 qualitative and mixed methods research projects, and published widely on mental health and risk assessment issues in mental health work; on young and adult offenders; and on violence from parents in child protection work.

He has presented at national and international conferences on the prevention and management of violence in health and social care, and he was a member of the   NIHCE Guideline Development Group for the 2015 report. He is currently co-applicant and Research Board member for a Health Foundation funded Closing the Gap Project on Prospective Hazard Analysis and Human Factors approaches in the NHS. He is a member of the National Institute for Health Research’s School for Social Care Research Advisory Board.

Future events of interest:

Masterclass: The Use of Restrictive Interventions: The legal framework
Tuesday 7 June 2016
Hallam Conference Centre, London

Download: Professor Brian Littlechild's full presentation

27 November 2015


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