A quick guide for registered managers of mental health services for young people
Quotations from young people who have experienced feelings of anger and aggression:
Violent and aggressive behaviours have a huge impact, affecting the health and safety of the young person as well as carers, staff and others using the service.
As far as possible, focus on preventing, anticipating and reducing the risk of violent and aggressive behaviour occurring.
Involve the young person in decisions about their care wherever possible, and collaborate with whoever has parental responsibility. When supporting the young person to manage and minimise any violent or aggressive behaviours, consider their physical, intellectual, emotional and psychological maturity, including any variation in their development.
"Difficult behaviour is usually the symptom of a problem and not the problem itself." - East Riding of Yorkshire Council
Preventing violent and aggressive behaviours
Understanding the likely causes of violent and aggressive behaviours helps to prevent them happening. Together with the young person, when they are in a calm and safe space:
Record this information in the care plan and support the young person, if they wish, to make an advance statement recording their wishes in case they become agitated in future.
This could include what they would find acceptable, when and how staff should intervene and how to minimise harm or discomfort should restrictive interventions be needed.
Give copies of this information to the young person and make sure they understand it.
De-escalation means using techniques, both verbal and non-verbal, to reduce agitation and avoid violent and aggressive behaviour. It may include the use of ‘when needed’ medication in combination with other techniques.
To help reduce the risk of violent and aggressive behaviours, and avoid the use of restrictive interventions wherever possible, staff should have training specific to working with young people. Training should include a focus on de-escalation and cover:
- the early signs of agitation, irritation, anger and aggression
- the likely causes of aggressive or violent behaviour
- de-escalation techniques and ways to encourage relaxation
- the importance of personal space
- how to respond to agitation in a reasonable and professional way that avoids provocation.
Anyone who might use restrictive interventions should be trained in how to do so safely with young people.
Staff should be aware of relevant legislation, organisational policies and procedures, and how to respond effectively and appropriately.
Share information within the organisation about the triggers and early warning signs identified by the young people using the service to help inform learning and practice.
- Violence and aggression: short-term management in mental health, health and community settings - NG10 (NICE guideline, which includes recommendations on a range of appropriate restrictive interventions).
- Violent and aggressive behaviours in people with mental health problems - QS154 (NICE quality standard).
- Decision making and mental capacity (NICE guideline).
- Children Act 1989 and Children Act 2004; Mental Health Act 1983, Mental Capacity Act 2005, Human Rights Act 1998, United Nations Convention on the Rights of the Child– relevant legislation
- Anger – YoungMinds resource that can help young people with mental health problems think about and understand their feelings of anger.
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This content has been co-produced by NICE and SCIE and is based on NICE’s guideline and quality standard on violence and aggression.