Clinical update

Violence at work

Incidents of violence and aggression are relatively common in health and social care settings, and the numbers are rising.

Essential facts

Incidents of violence and aggression are relatively common in health and social care settings, and the numbers are rising. According to NHS Protect, 68,683 assaults against NHS staff in England were reported in 2013/14 an increase of 8% on the previous 12 months. Of these reported assaults, 69% took place in mental health or learning disability settings. The figures include incidents involving the families or carers of service users. The National Audit Office estimates violence and aggression towards front line hospital staff costs the NHS at least 69 million a year in staff absence, loss of productivity and additional security.

Picture credit: Getty

The National Institute for Health and Care Excellence (NICE) has published updated guidance on the short-term management of violence and aggression in mental health, health and community settings. The guidance focuses on preventing violent

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Essential facts

Incidents of violence and aggression are relatively common in health and social care settings, and the numbers are rising. According to NHS Protect, 68,683 assaults against NHS staff in England were reported in 2013/14 – an increase of 8% on the previous 12 months. Of these reported assaults, 69% took place in mental health or learning disability settings. The figures include incidents involving the families or carers of service users. The National Audit Office estimates violence and aggression towards front line hospital staff costs the NHS at least £69 million a year in staff absence, loss of productivity and additional security.

Picture credit: Getty

The National Institute for Health and Care Excellence (NICE) has published updated guidance on the short-term management of violence and aggression in mental health, health and community settings. The guidance focuses on preventing violent situations and advises on managing incidents safely. Its new recommendations cover a broader range of settings in the NHS and across all health and social care provider organisations, and also cover children and young people aged under 16, family members and carers.

To reduce the risk of violence and aggression, NICE recommends comprehensive staff training. This should include an understanding of the relationship between mental health problems and violence or aggression, as well as the skills to assess why behaviour might become violent or aggressive and to recognise any early signs, and methods and techniques to reduce or avert imminent incidents. This could include verbal de-escalation, distraction techniques and ways to encourage relaxation.

NICE advises physical restraint should be used only as a last resort, once all other methods of preventing or calming the situation have failed and where there is potential for harm to the service user or other people if action is not taken. Where restraint is the only possibility, the guideline details how it should be undertaken to ensure the safety of staff and the individual. Techniques and methods should be the least restrictive option to meet the need, be proportionate to the risk of harm, be used for no longer than necessary, and take the person’s health and age into account.


Expert comment

Mark Haddad, senior lecturer in mental health, City University London

‘These updated NICE guidelines provide clear, accessible, practical and evidence-based recommendations that will be useful for everyone at risk, whatever setting they work in.

‘The guidance emphasises anticipation and prevention, rightly placing central value on the quality of relationships developed with service users, and highlighting the principles of person-centred and values-based care.

‘The recommendations resonate with the best practice I have seen in my clinical practice and academic work, and I am sure their implementation will improve the care experience.’


Find out more

NICE guidelines: Violence and aggression (May 2015)

Skills for Care: Violence against social care and support staff (November 2013)

Joint guidance: Preventing workplace harassment and violence

RCN: Work-related violence (October 2008)

NHS Protect

NHS Protect guide: Not part of the job – a guide to reporting assaults and violent incidents at work (June 2012)

NHS Protect guidance: Meeting needs and reducing distress project

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