De-Escalation in Mental Health Care Settings

De-escalation, the use of communication to calm a distressed or aggressive individual, is recognised as a first-line intervention in the management of aggression in mental health settings internationally. It provides a less coercive alternative to the use of mechanical or physical restraints, and it is a central feature of many leading complex models of care. Despite its prominence in policy, empirical evidence to support de-escalation techniques is only now beginning to emerge. Here we present an overview of the current evidence on nonphysical conflict management and interpersonal de-escalation in mental health settings alongside the practical approaches to implement these techniques in practice, illustrated by clinical examples. Together, we hope this chapter provides a comprehensive overview of the situational and interpersonal dynamics that contribute to effective de-escalation in practice and the principles that underpin them.