Tips for an effective de-escalation in mental health
Sometimes, taking a few minutes to listen and manage the situation can be enough to prevent a crisis from escalating in a person with mental health problems. This strategy is effective in reducing the incidence and severity of conflict and tension within or outside of a mental health service, but it requires technique and training. To learn these techniques and see examples of best practices, the World Health Organization (WHO) has dedicated its second training webinar to this topic. of the QualityRights , the training initiative on quality rights for people with mental health problems, is reviewing its de-escalation strategies. You can find this webinar and all the others in the series exclusively on our YouTube channel.
Active listening as a pillar
According to the QualityRights training materials, de-escalation is a technique for addressing situations in which people feel extremely agitated or upset , causing them to act in ways that can negatively affect themselves or others, either emotionally or physically. This can lead to very complicated situations that, at times, can even jeopardize the safety of those involved.
De-escalation is an approach that establishes a collaborative relationship with the key people involved in a conflict in order to resolve or alleviate the situation. This strategy employs effective communication techniques such as active listening . Active listening is a structured way of listening and reacting that focuses attention on the person.
Foster a culture of service based on human rights
Active listening involves attentively listening to what the other person is saying in order to understand their point of view and feelings. It requires focusing all your attention on the person and verifying that you have understood the genuine meaning of what they are saying.
Active listening also requires being mindful of not assigning personal meaning to what the other person is saying. It's about maintaining a dialogue with the person involved and valuing their feelings, thoughts, and ideas.
When interacting with a person who is expressing distress in a way that others perceive as upsetting or threatening, all people involved should make an effort to identify their emotional reactions, according to WHO training.
Tips to avoid an escalation of the conflict
De-escalation techniques may vary depending on the context and culture, but, in general, the basic tips for avoiding an escalation of conflict are:
- Respect each person's personal space.
- Avoid enclosed spaces, such as small rooms, to ensure the person does not feel trapped, cornered, or confined.
- Try contacting the person. Tell them you want to help and that you won't do anything against their will or anything that could hurt them.
- Avoid using language that could be perceived as provocative, humiliating, or condescending. Always be polite and respectful.
- Speak to the person with the appropriate level of formality, depending on your level of knowledge.
- Don't rush him. Give him time and space to process what he says and react.
- Try to understand the reason for their distress, as well as what they want and need. Ask them directly what they expect and what you can do.
- Ask him what would help and try to offer him some options and alternatives.
- Don't dismiss what the other person says just because you disagree. Look for common ground. If you can't agree on anything, then agree that you completely disagree.
- It makes it easier for the person to access people they know and trust.
- Once the difficult moment has passed, try to analyze with the person what happened.
Respond to people's concerns respectfully
The WHO webinar is led by Dr. Ahmed Hankir , a psychiatrist specializing in the UK and Canada, Honorary Visiting Professor at Cardiff University School of Medicine, and Adjunct Professor at the Schulich School of Medicine and Dentistry at Western University in Canada. Dr. Hankir is also a lived experience of mental health issues and an activist. He has documented his personal journey in the book *Breakthrough: A Story of Hope, Resilience, and Mental Health Recovery *.
"We invite you to stand in solidarity with people living with mental illness and psychosocial disabilities to contribute to a cultural revolution that empowers, dignifies, and humanizes us," Hankir begins in his presentation, "People living with mental illness have a voice. We can speak for ourselves, and we will be heard."
On this occasion, we were able to learn about the experiences and knowledge of Jennifer Kilcoyne , clinical director at Mersey Care NHS Foundation Trust and director of The HOPE(S) , a human rights-based clinical model for working with adults with autism or learning difficulties and children and young people.
Kilcoyne points out that "it's important to remember that most emotionally based interpersonal conflicts are usually related to people's unmet needs. As a result, they feel overwhelmed, distressed, frustrated, vulnerable, and anxious. What we must keep in mind is that the most important thing is to address their concerns."
“We must ensure we don’t re-traumatize them by making them feel powerless, mistreated, controlled, or rejected,” the speaker explained. For Kilcoyne, the first step is prevention , which means creating services and designing organizational cultures that meet people’s needs and address their physical and psychological safety. These are services that work in partnership with people, develop collaborative practices, and truly help them maintain their well-being. In this regard, she referred to the EDITION study, which analyzes organizational culture and how to better collaborate with people in services.
Good practices towards zero coercion in mental health
In her review of the main de-escalation techniques, the speaker emphasizes that "we have to make sure the person realizes that their concerns are important to us too, foster calm in that environment, and do things slowly. Give them time to process."
Ultimately, it's more important to try to establish a connection rather than control, because that will produce positive results for everyone, Kilcoyne says.
Gavin Harding , a mental health activist who works full-time for the UK's National Health Service (NHS) as a senior advisor on learning disabilities and was the first person with a disability employed in the country's public health system, also participates in the webinar. Harding shares his perspective based on his experience of being severely mistreated by mental health services in his country: "People with disabilities, when we are segregated and isolated, want staff who speak to us like any other human being. We want them to treat us kindly, as we treat them; that's how we want to be spoken to."
One of the most interesting contributions of this webinar are the role-playing videos with different crisis and de-escalation situations that are very useful to understand the importance of humanity and humility, and the care of mental health.
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