De-escalating Crisis Situations
As a psychiatric inpatient hospital worker, I appreciate the regularity with which crisis situations occur. For hospital workers of all sorts, encountering an angry or aggressive patient can be a daily occurrence, especially in psychiatric settings. Understanding how to approach such situations can make a significant impact on how they play out. Approaching an angry or aggressive patient requires tact and a level of care that may not come naturally to most people in similar encounters outside of a healthcare setting. Having gone through several de-escalation training sessions, I have come to value them as useful life skills both in and out of work. While some admittedly seem like they would be ineffective in the “real world” others are incredibly useful and have the power to keep people safe.
When confronting someone in crisis who is angry or generally not thinking straight, some of the best techniques I have used are as follows:
Ignoring the challenge - whether they’re challenging you directly or someone else, it is important to acknowledge threats as a potential reality, but to avoid focusing the ensuing conversation on it.
Focus on their feelings - simply acknowledging someone's feelings of frustration, or sadness etc. can be incredibly helpful. To some, they may seem obvious and like they don’t need to be pointed out, but sometimes people in crisis can lose track of their emotions. Simply hearing them labeled can bring them back into control.
Explore the consequences - this is an intervention that can work with those who are still ramping up. Simply asking the person what they intend to get out of their explosive or erratic behavior can trigger the logical brain to take over and “answer” that question. This can be enough to get someone back in control.
Offer choices - This works especially well in a position of authority. If you see someone becoming upset, destructive, or obstinate, offer them a choice. Saying something like “I can tell you need to vent, would you like to take a walk with me or would it be better to go lie down” can reframe the whole issue in their head. This can maintain the person’s sense of control while still successfully redirecting them.
Model good behavior - no matter which technique you use, it is important that you model appropriate behavior. Use a calm but stern tone of voice, and use slow and deliberate body movements. This helps regulate people’s emotional states on an unconscious level.
These are only a few examples of techniques that you can use to deescalate a situation. While many or even all of them may seem obvious, understanding them and practicing them can give you a better chance at using them successfully in a crisis situation. During these times, it is difficult to think straight, and having these top of mind can make a world of difference. Several studies have shown that staff training dedicated specifically to communication techniques and interventions can reduce the overall number of aggressive instances in a healthcare setting. This insight provided an opportunity to better prepare staff to manage such situations. As a result, violence, aggressive behaviors, and overall levels of distress, both for patients and staff can be reduced significantly. This highlights the importance of communication during stressful interactions, and the power in an empathetic approach.
I use these de-escalation techniques regularly, and while some of them might certainly take practice to master, I have found that others tend to manifest naturally with a patient-care mindset. However, I also recognize my own shortcomings, as there have been a number of situations I reflect on and recognize I could have handled differently. Watching expert engagement specialists work with troubled patients is delightful to witness and helps me understand their power and utility. Understanding the impact that such simple techniques can have on potentially hazardous situations makes me hopeful that they can become common knowledge. The more people know them, the better we can all preserve the peace.
