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In response to the #yegcc discussions on defunding EPS, some thoughts on deescalation in potentially violent situations, from a Registered Nurse with a background in forensic psychiatric settings.
A (probably) long thread/
#nursing #nurselife #mentalhealth #DefundPolice
A (probably) long thread/
#nursing #nurselife #mentalhealth #DefundPolice
My clinical experience lies primarily in maximum security forensic psych settings. Here are patients suffering from serious mental health issues who are involved in some manner with the criminal justice system.
Many patients here had the potential for serious violence, aggression, and/or self harm. Some patients, due to their mental illness and/or histories of trauma, could be unpredictable and escalate to anger and aggression very quickly.
My fellow nurses, psych aides and I used deescalation on a daily basis. Just us in our scrubs. No weapons. Security was available, but was only called in extreme situations. Things very rarely became violent because we all knew how to deescalate properly.
I once had a patient dismantle his bed and turn a piece of it into a giant knife. He threatened to use it. Nothing but me and my scrubs and my voice and my brain deescalated this situation to the point where he put down the knife. Security was called, but weren't needed.
How did I do it? I talked to him. I listened. I spoke in a calm voice. I acknowledged his concerns. I asked what I could do to help. We discussed solutions. We compromised. I took the time to do this. It took probably 30 minutes or more to do this.
Deescalation is exhausting. I've had patients threaten me, threaten my family. Tell me they'd find out where I lived. Tell me they'd kill me if they saw me on the street. Patients make racist, sexist attacks. They spit. Despite this, I was never aggressive with them. Never.
Why? Because an essential piece of deescalation is understanding why patients escalate in the first place. Psychosis, feelings of loss of control, histories of trauma, feeling threatened. When you understand this, it's easier to not take their attacks personally.
Patient histories of trauma are significant. We would only go 'hand-on' (physical restraint) as an absolute last resort. Because doing so can re-traumatize them. It can trigger their PTSD responses. It can decay what little trust you've worked to build with them.
My current research examines the strategies that nurses use to work with the most challenging patients you find in a maximum security forensic psych setting. What works? Being calm, being patient, listening to patients, taking the time to explain your actions.
What doesn't work? A hard no. Being impatient. Being inflexible. Being strict. Not taking the time to listen, not taking the time to consider a patient's concerns. When we do this, patients tend to escalate. They get angry. They get violent. It forces us to use restraints.
All these things you shouldn't do are exactly the tactics used by police. They say no. They expect compliance. They're aggressive with their language and their posturing. They see restraint as an early solution, not a last resort.
Yesterday a police officer in the #yegcc panels questioned how mental health workers could possibly deal with potentially violent individuals. I found this highly offensive. We do it all the time. We're very good at it. We keep violence from happening in the first place.
My patients have told me countless stories of negative interactions with police. Stories of police not listening, not understanding their mental illness. Stories of abuse. Stories of traumatization. Many people suffering from mental illness have had these negative interactions.
To the point where these folks do not trust the police. They're afraid of the police. And yet the police are usually the first to respond to mental health issues. This can change. This must change. Take this responsibility away from police and give it to mental health workers.
