De-escalation or punishment?

By a mental health practitioner.


Having worked in a variety of mental health settings over the past 13 years, I have worked with some great people, who like me, truly do have the well-being of the individuals we work with, at the heart of their practice. However, I have also sadly experienced some very poor practice from both individuals and teams, that has saddened me and at times made me question if I can continue to work in Mental health. Sometimes this is due to lack of training and experience, but other times has been due to people in the ‘caring’ professions who do not actually ‘care’ at all, and some I would go as far to say are nothing more than ‘bullies’, abusing their position of power over vulnerable people.

One incident in particular I remember is when I worked on an inpatient adolescent ward. On the ward we had a ‘de-escalation suite’ (DES) that was used to take young people if, due to their mental health problem, they were posing a risk of harm to themselves or others and other strategies to de-escalate the situation had failed. Alternatively it was used if it was felt they needed to be in a low stimulating area (particularly if someone was actively psychotic or in a manic phase of bi-polar). The DES consisted of a lounge area, bedroom, bathroom and kitchenette as well as an office for staff. It was a locked part of the ward and no young person was allowed to be in there without a member a staff. It was also stipulated that the young person should be in there for as little time as necessary.

On one Saturday I arrived at work and found that the young person who had been in the DES when I went off shift the evening before, was still in there. Not only that, but they were in there alone. They were sat by the door looking through the window of the door writing notes and holding them up so that the member of staff sitting there could read them, and the member of staff was doing the same. I asked if there had been another incident involving this young person, leading to them being returned there and questioned why they were in there alone. I was told that they had been in there all night and that the shift leader had no intention of letting them out any time soon as they were ‘fed up’ with this young person’s behaviour, which they felt, was not driven by a mental illness. They also were not prepared to let a member of staff sit in with the young person.

I heard from staff that this young person had been settled all night and displayed no evidence of aggression but was actually quite tearful at being left alone. I spoke to the shift leader about my discomfort about the situation and felt that as a team, we could not in any way justify what we were doing, but they ‘pulled rank’ and said that their decision was final. I continued to feel extremely uncomfortable about the situation and eventually contacted the on –call manager to express my concerns. They were in full agreement with me and the situation was resolved (not without causing some anger to the shift leader!!). In the shift leader’s defence, I can see that actually they were not intentionally abusing their position of power; they were trying to protect staff members from physical aggression and of course staff welfare has to be taken into consideration, but not at such a cost to the young person. I am not sure the relationship between me and that shift leader was ever the same again, but I have no regrets about what I did; I am just sorry it had gone that far.