Understanding Agitation: De-escalation
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- čas přidán 9. 07. 2024
- Agitation is an acute behavioral emergency requiring immediate intervention. In this simulation, Scott Zeller, M.D. demonstrates verbal de-escalation. De-escalation is highly effective and has been identified as the preferred intervention in calming a person experiencing agitation. This technique is also key to avoiding seclusion and restraint, which can be traumatizing to both patients and staff. The goal in verbal de-escalation is to help the person regain control so that he or she can better communicate needs with health care providers.
Production of the DBSA Understanding Agitation video series was supported by a contribution from Teva.
The actor, playing the patient, is absolutely flawless.
Well done all around.
Yeah absolutely best acting Ive seen in years!
It is quite realistic!
He’s not acting
He's got an empathetic manner . He gets on the level of the patient in trying to get along side of his concern . Speaking in a quiet calm manner . Body language good . not getting in his face. I like the asking him what the patient needs.
He is a wonderful Dr.
Thank you. I am so glad there are some people out there trying a compassionate approach to those in crisis.
They need a good swift kick.
“I’m here to help, not to hurt.”
Omg I’m using this in my new job as an MHA 🥺❤️❤️❤️
Girl same!
Unfortunately North America operates under the model of "I'm here to make you less annoying even if it hurts". I'm not saying nurses enjoy hurting their patients but will forcefully inject them as a means of silencing them and accept that some level of pain is necessary for control and then the patient will behave. If a man punches his wife, he typically doesn't enjoy inflicting the pain but believes that it is the best method of making her obey and become a good wife.
"You can get me out of this damn place."🧑⚕️
Excellent video. Thanks.
Very good actors.This is what truly happens in a typical Psychiatric Facility.
Not in a UK one. The Psychiatrst sees everyone once a week for 5mins max even on admission . Anything else, the staff either ignore or if you are a danger to them , they sedate. (A relatives experience over many years).
Yeah I’ve been in psych hospitals more than I can count and been restrained and secluded many times so I felt like the acting was pretty realistic too
90s 89
Can say for sure, I’ve been on both sides of this coin. 🤷♂️ it’s not fun either way, and it’s certainty a hassle to deal with staff who don’t care or don’t understand or both.
I find that much like with police work there are some clowns who roll in, stir the pot and leave it to overflow onto someone.
Same with security, some clowns stir the pot and someone gets hurt because they couldn’t just spend 5-10 minuets talking. Even if 30 minuets, it’s better than having to write a giant report explaining why 7 people got hit in the eyes and faces, why half the room is destroyed and why you’re having to restrain and handcuff someone under a sever mental breakdown while everyone is acting severely incompetent.
It looks stupid, it is stupid, it makes no one have any amount of trust or faith that you are going to do the right thing.
So, that 30 minuets of talking can help everyone... a ounce of prevention is worth a pound in action.
No it isn't.
EVERYONE should watch this. This is so practical, so helpful, and has none of the spiritual-touchy-feely-bs. It's all proper medical/psychological methods to help someone in distress. I love that.
You might have an interesting point, but the amount of jugdment behind your words make it sound just that, judgmental.
Maybe you can explain what you mean with that description, as there's both the so-called "spiritual bypassing" (or even a dissociated approach through an ideallistic "spirituality"), and also a serious spiritual approach such as S. Grof's one (see his and K. Grof's many books on the subject).
@@markelbaslo7362 if someone is clearly not into religion, don’t use religious beliefs to try and talk someone down or interact.
May just make it worse, or agitate someone.
excellent, I use CPI everyday at work. Sometimes people need to be listened to, vent, and have their anxieties averted rather than 2/5/and 50.
What is CPI?
This is a truly excellent video! While I’m not a healthcare provider by any standard, I work as a Security Enforcement Officer and have experienced situations such as this. It’s sometimes unnerving when you initially encounter a behavioral health emergency for the first time, and you may understandably be nervous when not knowing how to approach the situation and not knowing the person’s current state of mind.
Please don't ever send them to the cops if you feel they are in emotional distress, these patients don't belong in jail. Though some cops need more training on mental health,so they know what to do with patients like these. A criminal would not act in distress and do odd things, specially when they aren't hurting no one,they need help instead of sending them to jail like so states do.
Props to you for taking time to learn alternative techniques!!!
People just need to made to feel safe I fund if I say Everything going to be ok , your safe we are going to help you the patient looks you in the eyes they are looking for somebody they can trust because they are scared whitless when their mental health is unwell , always put yourself in their shoes how would you want to be treated,its nice to no you care.
In addition to the time it takes to restrain you have to document all of it afterward. If anyone gets hurt then you have to document the injuries as well.
2:36 when someone says they dont understand why they're here, you dont say: sit down.. excellent, thank you!
This video is de-escalating
He acknowledges the persons feelings. " It sounds like you're going through a tough time"
He goes with what the person is saying..
His body language is calm
Thank you so much for posting this!
Great message, great content. Thanks Dr. Zeller!
Respect and kind words help most of the time.
This is a good vignette for an average residential treatment facility. If you are looking for more low barrier this may not apply exactly. Scott has some great and important reframes that new social workers and the everyday person could use. The techniques he uses seem easy enough, but really need a lot of attention, since when you need them, it's easy to forget them, due to what happens to everyone when they get stressed: they rely on stuff they ingrained in themselves.
This is the best video I’ve seen on this topic. What a true to life scenario. Thank you for providing this to the public!
Thank you, you were so clear, precise and to the point.
*Only 18* 👇👇👇
256448.loveisreal.ru
Interesting video. I'm watching this right now for a new-hire safety orientation and Dr. Zeller is a rather knowledge man. The information provided in this video is sure to help me better address agitation and de-escalate situations of agitation.
Diffuse, calm and Resolve
Thank you this is so helpful and educational I appreciate it
i have learnt a lot through this video. Thank you
This video is so helpful. Thank you so much!
Have a patient exaaaactly like him. Very helpful
5 minutes? As a nurse, it has taken me anywhere from 15-30 minutes to talk someone down if they are highly agitated.
Booty juice is easier and faster.
@@alegriart you don’t think some patients are naturally resistant to deescalation? I mean in 1999 there was a hostage situation in a mental health hospital that lasted 2 days. The two hostages were both seasoned mental health nurses. And one was shot to death. Even with all their experience and expertise, they weren’t able to calm him down. A swat team had to take him out
@@cathydiane2558 can't tell u how many 'seasoned' mental health nurses actually suck at their job--and yes it's psosible to deescalate quickly and i think usually it can be done in less than 10 minutes, but some pts require more
@@oopalonga that’s why people are scared to go to the hospital and get help. People like nurse Rached from one flew over the cuckoos nest still kinda work in these places. Remember when mr cheswic was having an agitation over not getting his cigarettes. This is a different situation where the man is at the door wanting to get out and this is the first time a guy actually handled it completely right. I am glad we have a low amount of population that can actually help instead of act like nurse Rached
Thank you Dr. Zeller, I'm learning so much about myself with this insightful information.
Thank you
Restraint can agrivate the most graceful human, let alone someone locked in their own mind and unsure of the world around them.
This man does not look like he can physically fight someone. He looks like a depressed case. Maybe he gained an appetite from depression. Although just because he is a big guy, it doesn’t mean that he is depressed. The man knows himself better than everyone else. It could be a misunderstanding. It seems okay
@@laurieberry4814 this is an reinactment so of course he seems fine. And his weight has nothing to do with the situation at hand. I'm trying to understand the relevance of your comment in regards to my post. But yes everything does seems fine here because it's not an actual situation occurring in real time. I work with dementia patients and each person is unique and restraining then only causes irritation. Patience is key and paying close attention to the person they are will allow a worker to determine their next step 😁
In my experience working in Mental health facility when someone got to the unit agitared First thought in the staff mind it's give a shot in the butt. When we have a lot skills for deescaled patients. But mental health area in general need more people who really love what they do.
Lmfao,i was committed i tried to leave there was no talk, i was goven the booty juice and tied to a bed in a quiet room.
Prob because the butt shot works faster. Psych hospitals are often understaffed by exhausted, overstretched employees. So it makes sense they would rather shut a disruptive patient up with Ativan instead of spending time talking, walking, and negotiating
@@cathydiane2558 it sounds like one flew over the cuckoos nest movie stuff is still sorta going on. That’s why people are afraid to go to those places even now
What's agitared
@@cathydiane2558 Don't start justifying their tactics you naive girl. Being understaffed is never an excuse to abuse someone with painful chemicals they don't want in their body. To say otherwise means you agree with biochemical rape unless you're one of those who think pscyhotic patients are lesser humans with fewer rights. Why should psychosis strip the human right of bodily autonomy and consent to treatment? Even though injections are used on non-violent patients, violent patients don't deserve what you condone. Let me educate you on a device called a taser. Unless psychiatric nurses begin using that to subdue violent patients and cuff them, they will continue to deserve every punch a patient throws and we hope they all connect.
making them confess and perpetuating restrainment, they have the power
Cheers for the Video clip! I have learned a lot from this video, Big Al
Currently I am taking mental health Nursing this is so great ! ❤❤❤❤
he forgot the most important rule. Never tell a person in a very agitated state to calm down.
Most married men have learned to never say that to their wife.
Patrick L Exactly - I do not work in healthcare, but work as a Security Enforcement Officer and have had my fare share of encounters such as this, and having watched this video, it’s given me some extra and unforeseen perspective and alternatives as to how safely de-escalate the persons involved without inadvertently inflaming an already stressful and volatile situation.
@@HikerJohn316 - ha! true! true! true!
So true
Say what instead??
As someone who has suffered SEVERE anxiety and have lost myself to fear, I might mention to not directly face the person. Angling your body away, and NOT towards their escape route could be a way to seem less threatening. This demonstration was not for anxiety or panic, so no hate at all. Learning so when I become an EMT. During a severe panic episode I became very nonvocal and would lash out if cornered. What I would have preferred in those circumstances, had I been in a ward, would to probably have someone sit in the floor about half a room away, against a wall. Leaning against a wall and not looking, not talking, or doing something like fidgiting with a puzzle would have probably made me curious. Then again, My anxiety came out as very animal like behavior.
Interesting! You totally described what I found works best for my daughter. When she has panic attacks or is agitated, what works best is for me to sit or crouch against a wall with an open posture. I used to go as far away as I could within her sight. I turned 90 degrees to her to make it obvious I wasn't looking at her. I always left her an unblocked exit route. I said little, besides maybe something like "I'm here to help. You can come to me when you're ready." (Followed my gut on what to say when). It rarely happens at all anymore and thankfully her anxiety is almost behind us (except when puberty/hormones suddenly swell up). As her anxiety came down over the years, she preferred me to be closer and we talked more. With a stranger though, I think I would still start out the way this doctor did and if the person acted like they wanted to keep running away I'd let them know I'm there to help when they're ready and then move away, sit at 90 degrees, etc.
Thanks for the video.
Good job, tank's Doctor. The theme is very complex and very relavant. So, this video is important. I'm theacher, in a school have problem but don't have prepared people for emergency.
Could you have asked him if there was a safer place he would like to talk, within the building? For example, I would see if he would be okay talking in an area where are some windows, or at least offer him choice and movement within the escalation/frustration. Now obviously he may not have been safe to leave there, and perhaps the example of a locked exam room wasnt ideal. But I did think this was very empathetic, direct (no lying to the client about what is going on) and no convincing. Great job all together!
I really wish this was common practice, I had a horrible experience when I went to the hospital because I was having thoughts of wanting to harm myself. No one would tell me what was going on and I was told to sit down and be quite when I tried to ask questions about what was going on. Just talk to people if you made a mistake or you aren't sure of an answer just communicate that I just needed to know what was happening instead I felt I was shoved in a corner told I couldn't leave and treated like I had done something wrong.
I'm sorry you had this awfull experience, I've witnessed to often how patients suffer unesaseraly because of the uneducated and non sympathetic approach the patient, first and foremost people need to understand the patient is not "kicking off" to many time have I hear this and its heartbreaking, I've witnessed patients unesaseraly suffer because of the uneducated, I've seen the police turn up to a patients home to section a patient and go about it all wrong because the information they had been given down the line from family , crisis team, physiatrist the understanding the police officer had is there will be violence involved, every situation is different I witnessed a patient silently sitting in a bedroom in a bungalow the bedroom facing the front door of the house so when the police turned up the patient became very distressed the very large policeman then says " I dont want no trouble from you we are here to section you you need to get dressed and get in the police car " the patient becomes very distressed and says tearfully" what have I done am I introuble to which the poliman says hurry up and just get in the car , it took so long for me to explain to the police that the patient wasent violent but very scared because after 30years this is the treatment the patient has experience many times because the "professional " don't always have full knowledge of the situation or how to go about calming the outcome has to make it less traumatic for all concerned, it breaks my heart to see people suffer unesaseraly, im please to say the police that turned up on this occasion were willing to listen to what I had to say and buy the time we got the patient in the ambulance and into the mental health hospital the patient was linking the police officers arm convinced they were friends and had their best interest at heart , MORE NEEDS TO BE DONT TO HELP OTHERS UNDERSTAND THEY PATIENTS NOT "KICKING OFF" BUT IS SCARED "WHITLESS " 💔 sorry my msg is so long I'm just trying to make people more aware .
@@christineolsson1892 It's so true just some simple communication is all that's needed in so many situations. Just put yourself in the other person's shoes a moment and think about how scary the experience might be if it were you and what would help you feel calm and safe. Just speak calmly and if someone has a question just answer it instead of brushing them off. I feel like it's so true whenever it's a "mental health" situation it's just assumed the person is going to be difficult and in my experience they sort of treat you like a cross between a child and a prisoner who just needs to shut up and do as they're told. Having your agency completely stripped like that when you're already feeling so out of control just makes an already awful situation so much worse. Mentally ill people are just people going through a rough time treat them as such.
💔 so sorry you had that experience never give up telling your story people need to be educated more so they to can overcome their fear x peace and good health sweetheart ❤ 💜
Toll 👍🏻
Very well choreographed...very realistic! I am a medic who encounters this situation from time to time.
Please tell me you are not from Canada or the US. But just because you live in a better country doesn't mean it's the same everywhere else. I'm offended that you would not do research before making a blanket statement like that because you are invalidating the abuse that North American patients go through. If you lived in a country during the early 1800s that did not engage in the Atlantic slave trade, would you say that typically slavery isn't happening? Or would you broaden your biased viewpoint to see what is going on around the world before making a bold claim. To understand North American psych wards, jump to 7:36 of this video and read the right hand column. Unless you agree to orally take pills, this is the norm. They can inject patients with antipsychotic sedatives. The reason they do this is because psychotic patients have the same rights as unconscious patients meaning consent is not required. My first injection was disguised as a blood test. I'm sure you did not mean to offend psychiatric survivors and I forgive you. But I will be really disappointed if you are from North America and are that oblivious to what goes on at the psych wards you're referring to. Unless, of course, someone payed you or you were being sarcastic ;)
@@robertjameson8329 Hi Rebecca, understand where you are coming from. I was merely commenting on the 'simulation' this video is...just impressed by the acting skills, because it was so realistic. Under the Mental Health Act, patients do lose their autonomy with treatments, and treatment forced against the patient's will is undertaken everywhere in the world when the treating team feels that treatment is in the best interests of the patient. This is not undertaken lightly anywhere in the Western Hemisphere as I know it. Family members are consulted, and Independent Mental Health Advocates are approached where family is not involved. Furthermore, there is opportunity to appeal to the Mental Health Tribunal should there be disagreement between the treating team and family/IMHA. But I do not wish to diminish the distress of patients who are medicated against their wish. Happy to hear from you if you can suggest a way to provide a psychotic patient the treatment they need when the illness itself causes the patient to resist treatment.
By the way, I am from the United Kingdom
@@jacobbnjmnWhat you are describing sounds like a slightly better method and may be true for the UK. But in Canada and the US, once you are psychotic you are deemed dangerous regardless of you actions. Thus, if you don't take your meds orally, they can inject you without consultation all in the name safety which is a load of crap because even when locked in a secure isolation room, they burst in and inject you. Maybe it's just forced treatment. To answer your question, it doesn't matter if someone may be influenced by their illness when they say "no". Do you not believe in bodily autonomy or understand the trauma generated by violating it. If you don't want a chemical in your body and someone puts it inside you anyway, that is biological rape. This comparison isn't rocket science yet nurses still naively think they are actually helping when causing traumatizing physical and psychological pain. As for a solution, the only valid argument for using a tranquilizer is when someone is acting up dangerously and not routinely as a forced treatment plan. But if someone is dangerous just use a taser and cuffs because it is never okay to rape someone's veins.
@@robertjameson8329 I am shocked by the practice in the US as you describe it. Only agitated patients who are a danger to themselves or others are restrained and medicated in the UK, as far as I know.
What if he attack and try violent to escape
I get if I say something they can switch personality one minute nice sAy wrong thing they switch aggitation and cAn become violent need these skills
Sorry if the name looks different I’m in my moms phone. Yeah I experienced the same thing when I had to go back to a psych ward for the second time. I have autism and also have depression with a suicide attempt and when It was the second time I was going back I was having a really hard time and was refusing to go but I eventually went back and it was ok. And when I got used to it it felt like home I hanged out with a lot of people that were around my age witch was great and made my time there awesome.
Nice
Next is using the de-escalation strategies on the people who advocate for escalating to forcible detention, restraints, medication--
great!
Have you guys ever been taken to the ward?
Great video ✅
He makes very good points.
Love this video
This video is what being a good quality mental health professional is all about!
Can I have permission to add some of your video to my presentation?
20-25% of people who visit me also experience bouts of agitation
😅
This is very good training, thank you, J.L.M, (L.G. & mom)
I was hospitalized for psych before the nurse and doctor I had was very nice
I bet Dr. Zeller is helpful on bridges
GOOD JOB]
The patient seemed reasonable ...
Most people are when you just talk to them
Plot twist, he's not even a psychiatric patient, they just kidnapped this guy for their video
@@dbe_manny lol
Nice and informative video.
Can you imagine what this world would be like if everyone gave someone they don’t know 5 minutes
I think I saw these tactics in "Beau Is Afraid."
At 0.36, did the patient break wind through his agitation?
Neil Meekums it really sounded like it. Very air-biscuity sounding.💨
Ew....he farted up the room for Dr.Zeller
the choice he made was to go home
simple
anything else wont work
There are serious ethical issues around deciding on a treatment or way to handle an emergent situation *based on which method is faster and easier* - you should be deciding what is best (now and long run) for the *PATIENT* not for staff.
De-escalation is always best for the person, I'd wager.
Good actor👍
yes i have a patien acting like that the other day
People seems to get upset and aggressive when they feel threatened
so patronizing
Safe place for 72 hours then it’s the streets or jail son!
Acting is horrible. I did OSCES for 7 years including psychiatry. I walked out of my therapists ofc. 3 months ago. He is the only one I have ever seen that asks you to be there 30 minutes before my appt. It's a long day for me as I ride a medical bus to get there. Last visit I had the wait and the therapist kept me waiting over 30 min. for an hr. of therapy. So much could have helped to keep me from getting agitation like the receptionist telling me he was running late before I stood up to leave after an hr. wait. There is also a dr. board that names each dr. and says if they are on time, 15 min. late, 30 min. late and it wasn't on the board.
good acting!!
why are you trying to make him eat
try to put me in restraints ill fight for my life
never ever let me go if you do
I wake up feeling extremely agitated at night I can’t stop moving wringing my hands pacing etc. I’m a calm person though & nothing else wrong except the involuntary constant movement 😩😩 how can I stop it?
you need someone who knows how to listen to you and talk with you, i'd guess, but what do i know
Hi x I read your msg and I only want to help alittle if I can , hope your having a good day today x have you tried the calming anxiety videos you can Google, some are very good and there's lots to tuse from find the right one for you maybe it will help , also I know its not easy but at night when your paseing and agitated try to see it differently see it has if this is your way of coping with mental health say to yourself ok let's do this I will pase up and down 5times then I will sit down do this has much as you need to trying to slow your breathing and taking bk that you are the one incontrol x like I say I'm only trying to help alittle if I can just to show you that there is people out there who do simperthise with you , take care of yourself remember take one day at a time xx
Mr Smith is a great actor!!!
is this jeb bush
What if the patient farts ?
Thanks! What can you do when the agitation is faked to confuse you? How do you work a test into your calming communication to make sure he's not playing tricks on you?
Is it really fake though; is it not rather in order to protect the more vulnerable feelings beneath the agitation? Agitation giving Adrenaline, giving strenght? While fear, depression, etc gives weakness= not good for self-defense?
False arrest he is being detained against his will. Unless he has been arrested for something
I'm confused, is this No Neck Ed before 90 days or after?
I found the talking to me less scary then grabbing me
The reason people use medication to sedate a person is not because it’s faster but it’s easier for people who don’t know how to do their job which is use their words to help a patient to the best of your ability and people like that should not be in the psychiatric field
The veil is thin on this one.
This video should be called : "how to gaslight, torment, manipulate, control your victim when you have kidnapped someone, and are detaining them for committing no crime, against their will, and they are only trying to get away from their kidnappers before they are forcibly drugged and "helped".
This is rape guide for rapists. A psych facility is the most unsafe place a person can ever be condemned to, and this psych should have been charged with a felony the second he refused to open that door.
Yeah let him wander the streets so he can be assaulted or killed by police great idea
This is a whole lotta headcanon wth did I just read?
Getting certified, is this necessary when I already have common sense and know how to calm a hostile situation down. situation down
id refuse food and drink and meds if anyone else touched it
Where is this place at? Must not be in Oklahoma, cause cops aren't trained to take mental health patients to a mental health facility, here it's more convenient to take them to Jail, it creates more money for the courts and jail system. Oklahoma police needs more training on mental health.Wish all places would act like this one.
Im agitated beyond fart noises.
The sandwich did it!
I wouldn't be good at this at all.
"Love" the It's a safe place and Can make decisions. Nope nope.
he told you what would make it better but you denied it
after that forget it
patient is very agitatied.He was talked to in a calmly manner.
Yes listen to him. He wants to leave Listen to him. Duh.
#Psychical #PsychoticAttack #Awareness #Prevention #MinimumDanger #DecreasingPsychosis #schizophrenia
For honesty, the two should swap cloths and roles....as to give you true picture as to who should be the patient.
till i was home i wouldnt calm down
you would just make me hate everyone and fight all the time
Therapists routinely hurt, unaware what they say n do absolutely injure the minority most in need.
if i get restrained or drugged ..... i would be back to even the score