BackgroundService user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.AimsTo examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.MethodSystematic evidence synthesis.ResultsSynthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.ConclusionsService user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.

No abstract

De-escalation techniques are a highly recommended set of therapeutic interventions that are frequently used to prevent violence and aggression within mental health services. A thematic synthesis literature review identified 11 international papers. Seven themes emerged from the data synthesis. The first three related broadly to staff skills, including: characteristics of effective de-escalators, maintaining personal control, and verbal and non-verbal skills. The last four relate to the process of intervening and include: engaging with the patient, when to intervene, ensuring safe conditions for de-escalation, and strategies for de-escalation (including two sub-themes, autonomy confirming interventions, and limit-setting and authoritative interventions). De-escalation techniques are an example of a complex intervention, which has been overlooked by rigorous research, and it is often assumed that staff are able to perform these techniques in clinical practice. KEY WORDS: de-escalation techniques, literature review, nursing interventions, violence and aggression management.

BackgroundDe-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness.AimsTo conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training.MethodThe review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis.ResultsA total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and de-escalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results.ConclusionsIt is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects.