How to Manage Aggression in Behavioral Health Centers

It is easy to think of workplace violence as a problem that evolves from employees and their outside lives. However, workplace violence can be inherent in caring for those with behavioral health problems. In your role of providing services to your clients, you may encounter aggression, including verbal and physical altercations. Yet, you cannot simply turn to animalistic instincts without violating the oaths you have taken to protect and help them.

Behavioral and mental health problems change how a person thinks and reacts. While the majority of people with these conditions are not aggressive, the clinical environment, which includes rehabilitation facilities, they are at an increased risk for aggression, explains Medscape.

Your safety and the safety of staff members, other clients and surrounding people depend on your ability to effectively manage aggression in behavioral health. This includes understanding, developing and using strong communication skills with clients, physical de-escalation training and implementing, preventative measures, such as frequent rounding to check on them.

Communication Is Your Strongest Force to Manage Aggression

Clients may express feelings and thoughts before exhibiting aggressive behaviors. However, this is not the rule, and some may become physically aggressive without warning. This may include aggressive body language, such as jumping and threatening or engaging in physical harm to oneself or another. When a client becomes aggressive, intervention is necessary, and the situation demands split-second decisions. This begins the conversation side of managing aggression.

Acknowledge a Problem Exists

Aggression is usually a last resort for clients. In one study, reports the U.S. National Library of Medicine, persons served typically resort to aggression when staff members’ behaviors are perceived as custodial, not caring and compassionate. This results in the feeling of being ignored, so acknowledging the behavior and using the word, angry in this step, helps to bring the conversation to an audible level.

Staff Member: “I can see you are yelling and making fists. Are you angry?”

Determine the Reason for the Anger

This step helps you determine why a client is angry. Think of the traditional questions you ask when writing a grant proposal or official document, specifically open-ended questions.

Staff Member: “Why are you angry? What made you angry? Who made you angry?

For the purposes of understanding this topic, consider the following client response:

Client: “I’m angry because I have not received my medication yet.”

Return to acknowledging the problem after the client’s answer.

Staff Member: “You’re angry because you haven’t received your medication yet. Is that right?”

Client: “Yes. I need my medication.”

Offer a Solution, and Apologize

Staff Member: “I see there are two people in line before you. As soon as the medication aide has given them their medications, you will be next. I’m sorry that you have had to wait here so long. Can I stay with you to make sure you do not have to wait too long?”

If the client agrees to your suggestion, you have effectively eliminated the aggressive situation.

What If the Event Becomes Violent?

A client who does not respond to communication tactics or becomes physically aggressive toward himself or another person may require further intervention, requiring an appropriate, caring response. This includes the use of temporary restraint to remove the threat.

For example, a client grabs your hair in a fist. Place your hands on his hand, and hold the hand to your scalp firmly. Do not try to injure or cause harm to the client. Try to begin the communication part of aggression management. If that does not work, slowly weave your fingers through the fist to release your hair. It is imperative to continue using the communication step throughout the entire ordeal.

More stringent tactics may be used if necessary, but they require appropriate, in-person health and human services’ training. SAMA (Satori Alternatives to Managing Aggression), formerly known as PMAB, is a common type of training used in behavioral and mental health facilities. Additional training procedures are available through such training for managing clients who grab an arm, both arms or assaulting another client.

Above all else, if a client begins to exhibit any form of distress during any use of temporary restraint, explains the U.S. Department of Health and Human Services (DHHS), IMMEDIATELY RELEASE THE RESTRAINT.

What About Medication Management of Aggressive Behaviors?

Take a moment to think about this response to an aggressive situation in behavioral health. “What does he or she have available to calm him or her down?”

This does not solve the problem’s cause. However, it will help to de-escalate the situation. Furthermore, medication treatment of a client demonstrating aggression may take time to work. Even intramuscular injections do not produce instantaneous effects. Yet, if the aggression is the result of a psychiatric illness with psychotic symptoms, such as hallucinations from schizophrenia, the underlying cause may require nonpharmacological treatments over time, but immediate treatment may require medication.

The use of medications to “calm a person down” is a type of restraint. It is a chemically-induced restraint, and not adhering to a physician’s orders for the use of medications as a last resort can have serious financial and professional repercussions. For example, the state’s governing authority for behavioral health centers may investigate the incident.

Final Thoughts

A person with a mental health disorder may become aggressive, and chances are good that if you have never encountered a client in this state, you will sooner than you may think. If you react to this case of workplace violence with aggression and violence, you will only serve to further worsen the situation. Think about the numerous reports of spectators becoming involved in an altercation on the news. Anger only builds anger.

You need to fully utilize your communication skills if an event like this occurs. It is the only way to manage clients who have become aggressive. In addition, you must remember that if the client were not suffering, he or she would probably behave in a much more civilized and respectable manner.

Always show compassion in how you care for those with disabilities who have become overly agitated or angry by talking first before taking any physical action if the threat is only verbal. Even if it metastasizes into a violent situation, you can manage it with the proper skills and training. The role of communication cannot be overstated. Ultimately, you must not violate every client’s right to compassion and care with the least invasive measures in any behavioral health facility.

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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