The Effectiveness of De-escalation in Management of Aggression

A multicenter, intervention study will be conducted in all psychiatric hospitals in Slovenia. The purpose of the study is to evaluate the effect of verbal and non-verbal de-escalation techniques on the incidence and severity of aggressive behavior and on the incidence and duration of physical restraints. The proposed hypothesis is that de-escalation training and regular use of de-escalation can reduce aggressive incidents and the use of physical restraints in the acute psychiatric ward. In Slovenia, inpatient psychiatric treatment is provided by six psychiatric hospitals. There are two acute psychiatric wards in each hospital, one for male and one for female patients. All hospitals will be invited to participate in the study. The study will be carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. At the end of the baseline period, hospitals will be randomly assigned to either the experimental or control group. The intervention will include training on verbal and nonverbal de-escalation techniques for staff teams in experimental wards. The first part of the education is based on theoretical backgrounds: aggressive behavior in a psychiatric patient, risk factors, communication, de-escalation. The second part is a practical workshop. The training will be 16-hour duration in total. A short handbook and a list of verbal and non-verbal approaches will be prepared for all staff members involved in the training. For the baseline and intervention phase, data on the number and severity of aggressive incidents, the number and duration of physical restraint episodes, and the number of aggressive or restrained patients will be obtained.