How to address stressful situations in health and social services

In health and social services that care for people with mental health problems, situations of tension can occur that, if not addressed appropriately, can turn into conflicts.

These situations can be caused by both service users and people who work there, and the causes can be very diverse: misunderstandings or lack of communication, inflexible protocols or a person who feels that their wishes are not respected or not being listened to, among others.

Identify inappropriate responses

To better respond to these stressful situations, it is first necessary to identify the practices or responses that are not appropriate or effective in managing the situation. Some of them are:

• Yelling, usually to exercise control or authority.
• Threats, coercion or intimidation of the other person to do something.
• The use of physical force to practice forced manipulations (pushing, pulling, grabbing, etc.),
• Forced medication (for example, sedation to avoid certain behaviors perceived as challenging), which can deteriorate the relationship and trust between the person being treated and the professional team.
• Isolation and containment, which very often worsen the situation.

Inadequate responses can increase tension and stress , deteriorate the relationship and trust between the person being treated and the professional team or even lead to situations of violence, with serious consequences for the person and the teams.

Elements of appropriate responses

Responding to these tense situations in a timely and appropriate manner reduces the possibility of them escalating into conflict. Thus, it is essential to react in an attentive and sensitive manner, listening to what the person expresses, wishes and says that helps them and reduces their feeling of helplessness. In some cases, it may also be necessary to take measures for the safety of third parties, such as asking them to leave for another available space or to keep a certain distance.

The World Health Organization (WHO) QualityRights outline the elements of an appropriate response:

• Ask the person who is being alternated how they would like to be helped, what can help them feel better and calmer.
• Treat her in an empathetic and respectful manner, listening to her wishes and concerns, taking into account her life story and past experiences (especially traumatic events experienced) and trying to understand her feelings.
• Show understanding, patience and tranquility, staying calm.
• Give the person space and time to manage discomfort and tension.
• Seek non-violent solutions.

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In order to prevent situations of tension from becoming conflicts, it is also very important to identify and address sensitivities and signs of discomfort as soon as possible, in a respectful manner and with a comprehensive approach.

• Sensitivities: are situations or stimuli that generate a wide range of emotions and that can include discomfort, anger or frustration. They can occur in both the service user and the workers, family and other people in their immediate environment, and are different from one person to another. When many sensitivities of many people are activated with a high level of discomfort, situations of tension and conflict can occur. Some examples are: not feeling listened to, physical contact, loud noise, not being spoken to with respect, etc.
• Signs of discomfort: These are physical (external) signs that indicate discomfort in the person. It is important to detect them in order to identify and eliminate what is causing them, and help the person feel calmer. Some signs of discomfort may be: agitation, sweating, wringing the hands, breathing with difficulty, walking up and down, raising the tone of the voice or threatening to hurt someone.

Applying more appropriate response tools and strategies for stressful situations will reduce the likelihood of conflict situations occurring and improve the relationship between the person being treated and the professional team.

Strategies to deal with stressful situations appropriately

QualityRights also lists the main strategies for responding appropriately to stressful situations:

• Communication techniques , so that it is respectful, attentive, assertive, positive, empathetic, patient and sensitive to the person's culture. Among these techniques, the practice of active listening stands out.
• Supportive environments and wellness rooms . These rooms, for voluntary use and in no case as a place of isolation (the wellness space should not be locked), create a calm space where the person can get away from stress and relieve their discomfort in private. Wellness rooms may include the use of sensory stimuli to reduce anxiety and relax (music, relaxing colors, dim light, soft pillows, etc.).
• A culture of "yes" and "yes it can be done" . Create a space for professionals in which they can consider, without judgment, how decisions are made in the service and whether it is possible to answer "yes" to user requests instead of "no". Sometimes it will not be possible to meet all the needs raised by the person being served, and it must also be possible to explain this to them.
• Individualized plans that include signs of distress and sensitivities, and strategies and actions that the person themselves or others can take to respond to stressful situations and help them reduce distress, frustration, anxiety or anger. This plan should be made known to the other professionals who care for the person, the family and other people who care for them.

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• Response teams: a core group of professionals trained and empowered to intervene and respond safely, non-violently or coercively, to conflict situations, using communication and de-escalation tools. The response team may include mental health professionals and professionals from other fields, colleagues and community activists, family members and other caregivers. The composition will be tailored to the needs of the people being treated in the service. Their intervention will only be necessary when other strategies to manage the conflict situation have not been adequate or have not worked, since many times the person may just need time and space to deal with their discomfort (alone or with the help of professional teams or other people).

Knowing and applying more appropriate response tools and strategies for situations of tension, without using violence or coercion, will reduce the likelihood of conflict situations occurring, reduce tension and stress, improve the relationship between the person being treated and the professional team and avoid consequences that can be more serious.