Module: Ending coercion, violence &

abuse
How to manage and prevent coercion, violence and
abuse?
Tense situations typically result from miscommunications and
misunderstandings. They often arise when people feel like they are not being
listened to and become annoyed, distressed or agitated. When not handled
appropriately, tense situations have the potential to evolve into a crisis,
sometimes leading to the use of coercion and violence.

I. Appropriate and inappropriate responses to tense situations

When dealing with tense situations, it is important to:

 Think about the safety of all the people around (e.g. ask people whose
presence is not necessary to leave the room)

 Intervene early to ensure that the situation does not escalate into a
crisis

Here are examples of appropriate and inappropriate responses.

Appropriate and effective responses Inappropriate and ineffective

responses

 Treating the person concerned with  Seclusion and restraint

respect and empathy  Shouting
 Listening to their concerns and wishes  Threats and intimidation
 Trying to understand how they are  Forceful handling
feeling and acknowledging their feelings
 Asking them how they want to be *** IMPORTANT ***
supported/treated
 Being patient, supportive and reassuring The above responses can make people feel
 Giving the person space and time
even more helpless, distressed, resentful or
 Keeping calm
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 Finding a non-violent solution to a agitated. They are therefore damaging and
problem
can quickly escalate a situation to violence.

II. Triggers and warning signs

To prevent the escalation of a tense situation into a crisis, it is important to

identify the triggers and warning signs of people using the services, as well as
those of staff, families and others. Here are examples of triggers and warning
signs.

Triggers (i.e. stimuli) Warning signs (i.e. physical or outward

signs)

 Feeling like I am not being listened to  Restlessness, agitation, pacing

 People speaking disrespectfully to me  Shortness of breath or rapid breathing
 Other people using my things without  Sweating
permission  Clenched teeth, wringing hands
 Loud noises  Withdrawal, fear, irritation
 Being touched  Prolonged eye contact
 Not having choice, control or input  Increased volume of speech
 Aggression or threatening harm

Once triggers and warning signs have been identified, it is possible to put in
place key strategies to avoid and diffuse potential crises. They include:
 Comfort rooms and sensory approaches
 Creating a “saying yes” and “can do” culture
 Individualised plans to identify and manage triggers and warning signs
 Communication techniques
 Response Teams

III. Comfort rooms and sensory approaches

Comfort rooms provide an environment in which people can have some

space, feel safe and calm down. They are often used along with sensory
approaches, which are used to stimulate different senses (touch, hearing,
smell, sight and taste) to help a person feel calmer. Some examples include
music, massage, soft blankets, calming colours and aromatherapy, but this
would vary according to people’s preferences.

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Comfort rooms and sensory approaches should only be used with the
informed consent of the person. Comfort rooms should not be used as a
place of involuntary seclusion. People should never be locked in, or
prevented from, leaving the room.

IV. Creating a “saying yes” and “can do” culture

On admission to a service, people often surrender control to staff members.

This loss of control and dependency on staff can cause distress, anxiety and
frustration. This is particularly true when staff members are not responsive to
people’s needs due to heavy workloads, staff shortages, poor training, service
regulations or other reasons.

A key strategy is to create a “saying yes” and “can do” culture within the
service. Before saying an automatic “no” to requests from people, staff
members should first REFLECT on the request.
R – Reframe: What would it take to say yes?
E – Easy: Is “no” the easy option?
F – Feeling: What would it feel like for the person if I say “no”?
L – Listen: Have I really listened to the person concerned and what
they are asking?
E – Explain: Can I explain to the person concerned why I am unable to
meet their request?
C – Creative: Are there creative ways I could use to try and find a way to
meet the request of the person?
T – Time: Am I giving enough time to consider the request?
Source: Adapted from Manaan Kar Ray & Sarah Rae. ‘No Audit: Reflect to Reframe’ in Power
to empower Lies beyond Binaries. PROMISE: PROactive Management of Integrated Services
& Environments. Cambridge University Health Partners
http://www.promise.global/2015_04_09_Binary.pdf

Another important question to be considered by staff is: can I give resources

to people using the service so that they do not need to make this request and
can be more autonomous?

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 V. Individualised plans

Individualised plans can help to better understand what makes a person feel
distressed or agitated and also what helps them to feel calm.

To develop such a plan, a person must:

 Identify triggers and warning signs that could potentially lead to a tense situation
 Outline agreed upon calming methods that can be used to manage and prevent the
escalation of a tense situation

Examples of calming methods widely vary from person to person but can
include:
 Going for a walk/getting some fresh air
 Having someone acknowledge my feelings
 Taking slow, deep breaths
 Squeezing a ball or blanket
 Being able to yell or cry
 Spending time in a comfort room
 Speaking to a friend or family member

An individualised plan can be a stand-alone document or part of an overall

recovery plan or advance plan/directive. Individualised plans should be
accessible during tense situations (e.g. on record in the service, online
registry…). If a person has developed an individualised plan, they should let
all relevant people know about its existence so that they can support the
person to implement the calming strategies identified.

Mental health and other practitioners, families and other supporters should
also develop their own individualised plans. They too are likely to have triggers
that can affect their behaviour in challenging situations. It is therefore
important for them to identify calming methods that work for them.

VI. Communication techniques

Good communication skills are essential to manage tense and challenging

situations. Communication should be:

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Respectful: Treating everyone in the situation with respect and dignity.
Attentive: Devoting full attention to the person concerned (i.e. active
listening).
Affirming: Supporting and encouraging the person’s ability to find ways to
calm themselves and resolve the situation.
Positive: Encouraging the person to focus on positive aspects of the
situation.
Empathetic: Putting in effort to understand the thoughts and feelings of
everyone involved.
Patient: Taking as much time as necessary to hear the concerns of the
person and reach a fair and peaceful solution.

The following are examples of phrases, which have been identified as being
helpful by some users of services in New Zealand – they will not be helpful for
everyone:
 You can count on me.
 You don’t have to prove anything to anybody.
 I know you will get through this.
 Always focus on remembering your achievements… not only your problems.
 How can I help you?
 Tell me what you want/need.
 I am here to listen.
 I respect your views.
 We can work together through this.
 It’s OK to feel like that.
 Don’t give up.

Source: Adapted from Mary Ellen Copeland, Mental Health Recovery Newsletter, February
2002, cited in Roadmap to Seclusion and Restraint Free Mental Health Services. DHHS Pub.
No. (SMA) 05-4055. Rockville, MD: Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, 2005, Module 5 pp. 43-44.

Active listening is a key aspect of good communication. By giving your full

attention to the speaker, you are in a position to better understand their
thoughts and feelings. It is not about agreeing or disagreeing with the
speaker, it is about repeating in your own words what you think they have
said in order to make sure you have understood them (and thus avoid
misunderstandings).

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When people feel that they are being listened to, they are more likely to
open up, allowing for a peaceful resolution to the situation. Here is a video
example.

Video: Understanding Agitation: De-escalation

https://youtu.be/6B9Kqg6jFeI?t=207
Source: Depression and Bipolar Support Alliance

VII. Response Teams

A Response Team (RT) is a group of people within a service who are

responsible for responding to a crisis in a short period of time. They are trained
to manage crises using communication and de-escalation skills.

An RT intervention focuses on the development of a non-intrusive, non-

controlling, non-confrontational and highly empathic relationship with the
person in crisis. They do NOT use seclusion, restraint, forced medication,
sedatives or tranquilisers. When available, RT members access individualised
plans, advance and/or recovery plans to respond according to the person’s
will and preferences.

RT members can include mental health and other practitioners, people with
psychosocial disabilities, people with intellectual disabilities, people with
cognitive disabilities, peer supporters, community advocates, family
members, etc. In addition, there can also be “on-call members” who are
called on a needs basis.

Once the crisis has been resolved, there should be debriefing sessions:
 With the person concerned (when they feel ready): to better understand what the
person went through, how appropriately the RT dealt with the situation, and to
develop or review their individualised plan.
 With other people (e.g. family members, caregivers and other supporters): to identify
what led to rising tensions and how to better manage the situation in the future.
 With RT members: to discuss what worked, what did not work and how to improve.

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It is important to note, however, that an RT intervention is only necessary in
certain situations where other strategies are not appropriate or have not
worked. In many cases, people may simply need some time and space to
overcome their distress, on their own or with support from others.

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