June 1, 2015

Restraint as a Last Resort: updated NICE guidance to safeguard NHS staff from violent and aggressive patients

The number of reported assaults against NHS staff has increased by 8 per cent from 63,199 in 2012/13 to 68,683 in 2013/14.  The majority of these - 69% - occurred in mental health or learning disability settings.

Violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security.

The updated guideline on the management of violent and aggressive behaviour in people with mental health problems covers the short-term management of violence and physically threatening behaviour in psychiatric settings, emergency and urgent care services, assertive community teams, community mental health teams and primary care.

Physical restraint as the last resort

The guideline recommends that physical restraint should only be used as a last resort, once all other methods of preventing or calming the situation have failed. However, if restraint is the only course of action available, the guideline includes clear recommendations on how it should be done to ensure the safety of both staff and the individual.

Other recommendations include offering staff training so that they have the skills to defuse a potentially violent or aggressive situation. Staff training in de-escalation should enable staff to recognise the early signs of agitation, irritation, anger and aggression, use techniques for distraction and calming, and ways to encourage relaxation.

The guideline also makes recommendations on what to do if children and young people become aggressive or violent.