MANAGEMENT OF AGGRESSIVE BEHAVIOUR IN PSYCHIATRIC SETTINGS
The Use of De-escalation And Restraint Techniques In Controlling Aggressive Behaviours
Keywords:
mental healthcare act, 2017 (MHCA 2017), restraint, de-escalation, aggression management, patient safety, least restrictive intervention, psychiatric emergencies, Broset violence checklist (BVC), rapid tranquilisation, behavioural crisis managementAbstract
Patients receiving mental health care may occasionally exhibit severe aggression or violent behaviour that poses a risk to themselves, other patients, caregivers, or healthcare professionals. In such situations, ensuring safety while preserving the patient's dignity, rights, and autonomy is of paramount importance. The Mental Healthcare Act, 2017 (MHCA 2017) provides clear guidance that restraint should never be used as a routine treatment intervention but only as a last resort, after all appropriate alternatives have been attempted. Whenever restraint becomes unavoidable, the least restrictive method should be employed for the shortest duration necessary, with continuous monitoring and appropriate documentation. This article outlines the principles and standard operating procedures for the safe and ethical management of aggressive behaviour in psychiatric settings. It emphasizes the importance of early identification of aggression, preventive risk assessment, verbal De-escalation, one-to-one observation, appropriate use of restraint, post-restraint monitoring, documentation, and multidisciplinary teamwork. The article also highlights the legal and ethical responsibilities of healthcare professionals in ensuring that all interventions comply with the provisions of MHCA 2017, while maintaining patient safety, human rights, and professional standards of care.