Aggression in mental health care: Opportunities for the future—A qualitative study on the challenges when defining and managing aggression across inpatient disciplines

Abstract

Accessible Summary What is known on the subject? Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub‐par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. What this paper adds to existing knowledge? Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non‐coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. What are the implications for practice? It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de‐escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non‐coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well‐being of healthcare workers is also needed. Abstract Introduction Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non‐coercive measures. Aim The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. Method A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. Results Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. Discussion In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non‐coercive techniques do not work. Aggression is considered an integral part of the job indicating an “aggression‐tolerating” workplace. Imp...

Elimination of restrictive interventions: Is it achievable under the current mental healthcare landscape?

“…For many mental health nurses who are often called on to implement restrictive interventions, physical or mechanical restraint are not used lightly, and are often a last-ditch effort to provide safety and security for the consumer, themselves, and other people in mental health services where other methods have failed (Soenen et al, 2023). Removing these interventions without a valid, tested alternative will arguably lead to injury to staff and consumers.…”