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Prevention and Management Strategies for Aggression/Behaviour of Concern among Persons Living With a Mental Illness

Aggressive behaviour among patients with mental illness is a common phenomenon but it is challenging to determine its prevalence. However, violence occurs at the primary care and community setting with the victims being the patient, healthcare providers or the public (O'Rourke, Wrigley & Hammond, 2018). According to (Pompili et al., 2017), an increase of aggressive behaviours is observable in patients with severe mental illness which represents a The prevention and management of aggressive behaviours among mentally ill patient have taken a new perspective with an emphasis on the use of non-coercive approaches. This has replaced traditional methods of treating agitated patients which include routine restraints and involuntary medication. An effective evidence-based practice is a verbal de-escalation which is a three-step approach that has proven efficient in helping violent patients. Verbal de-escalation is a clinical challenge for mental health nurses. Aggression is the major cause of psychiatric hospitalization and leads to prolonged stay in the hospital, suffering, and stigmatization. The source of stigmatization towards psychiatric patients is the fear of irrational behaviours or loss of control.

One in four adults in the UK and Ireland experiences a mental health problem. Moreover, 8 in 100 people see physicians (GP or family doctor) on mental health-related problems. At every given time, six people including spouses, family members, carers, and friends are at risk of violence related to mental health (O'Rourke, Wrigley & Hammond, 2018). Violence within the healthcare setting is a concern for patients, clinical and nonclinical staff as well as members of the public. According to the World Health Organisation (WHO), stigmatization and history of substance abuse are significant risk factors for aggression among psychiatric patients (Jack et al., 2015). Pompili et al. (2017) highlight gender, age, history of violence and self-destructive behaviours, and diagnosis of schizophrenia to increase the risk of violence. Since aggressive behaviour hinders effective and efficient intervention, mental healthcare providers should use supportive language and pharmacological intervention as preventive measures while utilising seclusion with or without restraint and restraint, and environmental interventions to manage the behaviour.

non-coercive method involving three stages. The nurse engages the patient verbally to establish a collaborative relationship that leads to verbal de-escalation out of agitation (Varghese & George, 2017). The verbal de-escalation on the supportive language approach focuses on engaging the patient and making him/her an active partner in the evaluation and treatment process as well as environmental planning to eliminate and manage the triggers. The objectives of the intervention are to ensure the safety of the patient and healthcare providers, help the patient to manage emotions and regain control of behaviour, avoid the use of traditional methods (restraints), and avoid coercive intervention that might promote aggressiveness. Since agitation is a behavioural syndrome connected to different emotions, the success of this strategy depends on the training of healthcare to acquire specific skills and attitudes (Richmond et al., 2012). Agitation varies from anxiety to high anxiety making the patient unable to engage in a conversation or place him/her at the edge of new or repeated aggression.

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