Mental health assessment

Assessment

• To avoid escalation of behaviour, only collect information that will assist in initiating care and keeping the patient safe. The mental health team or medical or nurse practitioner will undertake a full history on examination.
• If the patient has a history of acute behavioural disturbance (ABD), find out what supports, if any, are already in place.
• Find out what has worked in the past, and if there is an existing behaviour management plan.
• Discuss the history of the episode, e.g. details of what happened today.

De-escalation

Aims

• Verbal and non-verbal de-escalation is a first-line intervention.
• Treat the underlying cause.
• Debrief the child and/or family and staff.
• Involve senior staff early.

Environment

• Provide a calming space, e.g. quiet room, soft or decreased lighting and eliminate triggers for agitation.
• Remove other children, visitors and staff. Consider family member or carer presence on a case-by-case basis.
• Take safety precautions by removing weapons and obstacles. Remain vigilant about the nearest exit to prevent potential escalation and ensure personal safety.
• One senior staff member communicates with the patient and carer.

Child

• The most important initial action is to reduce the behaviour to minimise distress and any risk of harm.
• Listen and talk simply in a calm manner.
• Respect personal space.
• Check for any alerts and familiarise yourself with the patient’s history, e.g. previous incidents of agitation, known medical, developmental or behavioural issues.
• Consider the patient’s individual needs, including language, cognitive ability or trauma history.
• Consider the use, where appropriate, of:
• age-appropriate distraction techniques, familiar toys and objects
• offers of food, drink, icy-pole, or attention to physical needs.
• To prevent crisis, anticipate and identify early irritable behaviour. Consider past history and involve mental health expertise early.

Staff and self

• Introduce yourself and emphasise collaboration.
• Minimise behaviours and/or interventions that the patient may find provocative.
• Use a calm, quiet tone of voice and use concise non-judgemental language and expectations:
• Focus on one idea at a time.
• Actively listen, especially regarding the patient's goals.
• Provide an opportunity for the patient to regain control of emotions.
• Set clear limits on behaviour for the patient and carer.
• Offer clear choices and negotiate realistic options. Avoid 'bargaining'.
• Maintain professionalism at all times, ignoring insults and challenging questions.

Observe

ABC mental health assessment

• Appearance – includes affect and mood:
• Observe if the patient is engaging with staff and/or family.
• Describe the patient's mood, e.g. euthymic (normal), depressed, sad, teary, withdrawn, irritable, mad or angry.
• Look at their posture, grooming, body appearance and condition.
• Behaviour – includes cooperation:
• Describe features, such as mannerisms and tics, and descriptors of the patient's behaviour, e.g. agitated, distressed, aggressive or impassive.
• Look for indications of escalating behaviour.
• Cognition and conversation – includes speech and thought:
• Level consciousness, e.g. alert, drowsy, stupor or coma, orientation, attention and concentration
• Rate of speech, e.g. slow, normal, rapid or pressured
• The volume of speech, e.g. soft, normal or loud
• Quantity of speech, e.g. spontaneous, normal or talkative
• Quality of speech, e.g. accent, rhythm or impediments.