Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg25
Legal preface
This guideline makes recommendations about the short-term management of disturbed/violent behaviour in adult psychiatric in-patient settings and when service users present for mental health assessment in emergency departments. This takes place within a multi-faceted legal framework, compliance with which is a core measure of quality and good practice. For example, the management of disturbed/violent behaviour frequently involves interventions to which an individual does not – or cannot – consent. It is especially important that such interventions are in accordance with best practice.
Failure to act in accordance with the guideline may not only be a failure to act in accordance with best practice, but in some circumstances may have legal consequences. For example, any intervention required to manage disturbed behaviour must be a reasonable and proportionate response to the risk it seeks to address.
The service should ensure access to competent legal advice when required in relation to the management of disturbed/violent behaviour.
The law provides the authority to respond to disturbed/violent behaviour in some circumstances, and it sets out considerations that are extremely important when service providers have to decide what action they may take. The contribution of the law to the management of disturbed/violent behaviour should be recognised as positive and facilitative.
All those involved in the short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments should:
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be familiar with, in particular:
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the relevant sections of the Mental Health Act 1983 and its Code of Practice
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the principles underlying the common law doctrine of 'necessity', and
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the requirements of the relevant articles of the European Convention on Human Rights, including Article 2 (right to life) and Article 3 (the right to be free from torture or inhuman or degrading treatment or punishment), Article 5 (the right to liberty and security of person save in prescribed cases) and Article 8 (the right to respect for private and family life), and the principle of 'proportionality'
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the Health and Safety at Work Act 1974, which place duties on both employers and employees, and applies to the risk of violence from patients and the public
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the Management of Health and Safety at Work Regulations 1992, which place specific duties on the employer to ensure suitable arrangements for the effective planning, organisation, control, maintenance and review of health and safety (these duties include ensuring that the risk assessments are undertaken and implemented)
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receive regular training on the legal aspects of the management of disturbed/violent behaviour
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ensure that a comprehensive record is made of any intervention necessary to manage an individual's disturbed/violent behaviour, including full documentation of the reason for any clinical decision
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ensure or contribute to ensuring that all aspects of the management of disturbed/violent behaviour are monitored on a regular basis, and that any consequential remedial action is drawn to the attention of those responsible for implementing it
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be aware of the obligations owed to a service user while his/her disturbed/violent behaviour is being managed, and of parallel obligations to other service users affected by the disturbed/violent behaviour, to members of staff, and to any visitors
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ensure or contribute to ensuring that any service user who has exhibited disturbed/violent behaviour should not be the subject of punitive action by those charged with providing him/her with care and treatment, and that where the disturbed/violent behaviour is thought to warrant criminal sanction, it is drawn to the attention of the proper authority.