Scope: Disturbed (violent) behaviour, the short-term management of disturbed (violent) behaviour in inpatient psychiatric settings
1 Guideline title
Disturbed (violent) behaviour: the short-term management of disturbed (violent) behaviour in inpatient psychiatric settings
1.1 Short title
Disturbed (violent) behaviour
a) The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Collaborating Centre for Nursing and Supportive Care to develop a clinical guideline on the short-term management of disturbed (violent) behaviour in inpatient psychiatric settings for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and National Assembly for Wales (see Appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.
b) The present guideline will update and extend the previously published guidance Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services produced by the Royal College of Psychiatrists (1998).
c) For the purposes of the present guideline, short-term management is defined as the response to disturbed (violent) behaviour occurring immediately before or after the event, with consideration of interventions that extend to no more than 3 days after the disturbed (violent) behaviour.
d) The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical guidelines and technology appraisals published by the Institute after an NSF has been issued will have the effect of updating the Framework.
3 Clinical need for the guideline
Disturbed or violent behaviour by an individual in an adult inpatient psychiatric setting poses a serious risk to that individual, other service users and, particularly, to staff. In 1998/99, an NHS Executive survey found that there were approximately 65,000 violent incidents against staff across the NHS. The average number of incidents in mental health/learning disability trusts was over three times the average for all trusts. The Mental Health National Service Framework stipulates that staff should be competent to assess the risk of violence, manage individuals who may become violent, and that staff should know how to assess and manage risk and ensure safety. The effective short-term management of disturbed or violent behaviour is a means of helping to minimise the risk of injury to the individual patient, other service users and staff involved in these types of incident.
4 The guideline
a) The guideline development process is described in detail in three booklets that are available from the NICE website (see 'Further information'). The Guideline Development Process - Information for Stakeholders describes how organisations can become involved in the development of a guideline.
b) This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider. The scope is based on the referral from the Department of Health and National Assembly for Wales (see Appendix).
c) The areas that will be addressed by the guideline are described in the following sections.
4.1.1 Groups that will be covered
a) Adult service users ( >16 years) who are currently admitted to inpatient psychiatric settings.
4.1.2 Groups that will not be covered
a) Adult psychiatric service users not currently admitted to inpatient settings.
b) People with learning disabilities.
c) People with a primary diagnosis of substance abuse.
d) Children or adolescents (<16 years).
e) Older persons with an organic mental disorder (e.g. any form of dementia) or a progressive neurological disease (e.g. Parkinson's Disease).
4.2 Healthcare setting
a) The guideline will cover the care received from healthcare professionals who have direct contact with and make decisions concerning the care of NHS service users in adult inpatient psychiatric settings (including high-, medium- and low-security psychiatric hospitals and NHS hospitals).
b) The guideline will also be relevant to, but will not cover, practice regarding:
c) This is an NHS guideline. Although this guideline will address the interface with other services, such as those provided by social services, secure settings and the voluntary sector, it will not include services exclusive to these sectors.
4.3 Clinical management
The guideline will include advice on the short-term management of disturbed (violent) service users in adult inpatient psychiatric settings; this will cover the following areas.
a) The identification of potentially violent service users (for example, the use of psychometric instruments, the responsibilities of staff and management, risk assessment).
b) The use of de-escalation and other short-term psychosocial intervention methods aimed at preventing the occurrence of violence.
c) The use of seclusion.
d) The use of physical restraint (for example, mechanical restraints, 'control and restraint' procedures).
e) The use of rapid tranquillisation if short-term psychosocial intervention methods have failed.
f) The training or education requirements for the above-mentioned interventions.
Advice on treatment options will be based on the best evidence available to the development group. When referring to pharmacological treatments, the guideline will normally recommend use within the licensed indications. Exceptionally, and only where the evidence supports it, the guideline will recommend use outside the licensed indications. The guideline assumes that prescribers will use the Summary of Product Characteristics to inform their prescribing decisions for individual service users.
4.4 Audit support within guideline
Level two audit criteria will be identified within the guideline.
This is the final version of the scope.
The development of the guideline recommendations will begin in March 2002.
5 Further information
Information on the guideline development process is provided in:
These booklets are available as PDF files from the NICE website (www.nice.org.uk). Information of the progress of the guideline will also be available from the website.
Appendix - Referral from the Department of Health and National Assembly for Wales
The Department of Health and National Assembly for Wales asked the Institute:
"To prepare clinical guidelines for the NHS in England and Wales for the short-term management of disturbed (violent) behaviour in inpatient psychiatric settings, including consideration of pharmacological, physical (including seclusion and restraint), preventative and psychosocial interventions."
This page was last updated: 30 March 2010