De escalation techniquesmental health PDF

In routine cases, officers will be allowed to view video before preparing reports and in preparation for a court proceeding. In officer–involved shootings, use-of-force cases, or when police misconduct is alleged, access to the video may be restricted and officers will only be able to view video at a time allowed by the supervisor in charge of the investigation. This includes before making an official statement in the course of the investigation. The technology does not enable officers to edit or delete any video evidence.

In comparison to other wards, the risk for aggressive behavior is increased in mental health units (13). In mental health departments, conflicts can arise as a result of interpersonal interactions between staff and patients and also between patients. De-escalation has been defined as the use of techniques including verbal and nonverbal communication skills aimed at defusing anger and stopping aggression (14). It is an approach for managing aggressive and violent behavior in a more humane manner and is arguably more dignified and less coercive than physical interventions. In addition, this guideline (14) highlights how medication can be used as a part of de-escalation strategies, but medication does not stand for de-escalation on its own. De-escalation also involves the use of verbal and physical expressions of empathy, creating therapeutic alliance, and nonconfrontational limit setting that is based on respect. The pivotal strategies focusing on de-escalation are communication, approach, de‐escalator qualities, assessment and risk, getting help, and containment measures. Different types of aggression are met with different interventions (15).

There are several concepts that address aggression, but little is known about successful strategies to prevent and deescalate aggressive behavior (16). Gaynes et al. (16) found in their systematic review that if there is a risk of aggressive behavior, multimodal approaches like the “Six Core Strategies” have the potential to reduce the use of restraint and seclusion. The “Six Core Strategies” were developed and supported by the National Association of State Mental Health Program Directors in the USA (17) to prevent aggressive behavior. One of its pivotal strategies concerns the commitment of institutional management such as the Chief Executive Officer (CEO) or chief medical doctors/head nurses. Leadership is described as not only the commitment to a vision, an attitude, and a plan to reduce the use of seclusion and restraint, but also the involvement of management in those practices (17). The second strategy is the use of data to inform practice, which means the monitoring of units’ or shifts’ rate of seclusion and restraint and of patients’ characteristics. The third strategy focuses on development and training of the teams toward a recovery-based treatment environment. The training involves, among other things, the exploring of rules. The authors claim—as mentioned above—that closed wards often have historic rules and procedures that are no longer appropriate to state-of-the-art treatment and not in line with a recovery-oriented, least restrictive practice (17). The fourth strategy concerns the use of prevention and assessments tools, and the fifth strategy concerns the inclusion of the patients themselves in improvement strategies or facility committees. Moreover, the inclusion of family members or peers is recommended. The last strategy focuses on debriefing techniques that aim to reduce the traumatizing effects of coercive measures for both patients and staff. Detailed, recommended questions units can ask themselves, exploring potential triggers, are, for example, “was the individual worried about anything?” or “did the individual have to wait an inordinate time for something he or she wanted?” (18). Steps for debriefing and procedures are explained and templates are available.

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Any events for which recording is required must be recorded from start to finish. If a member of the public asks an officer to turn off the camera, the officer may do so, but may continue recording if the officer thinks it unsafe or inadvisable to stop. Officers may not turn off the camera if a suspected perpetrator is still present on the scene.

The spontaneous response to an aggressive behavior depends on how it was perceived, experienced, and interpreted, and depends on the attitudes and values of the perceiving person itself.

Nursing practice is often characterized by relatively close physical contact for extended time periods, sometimes lasting over hours. Also, due to this, nurses in the psychiatric setting may be familiar with aggression toward them (20). It is known that targeted aggressive behavior can lead to anger, and (unreflected) anger can lead to reactions, which are disciplinary or even coercive (21). A strategy of de-escalation with commonly shared procedures, as the two models described before, can support balanced alternative reactions of nurses and other health professionals in a treatment team. That is why we recommend multimodal de-escalation strategies encompassing several different approaches.

It is not only formal coercion but also informal coercion that is looked upon as negative and often hampers a therapeutic relationship (4, 5). Informal coercion is common but underestimated by health professionals (6). Informal coercion or treatment pressure (7) comprises subtle forms of communication mostly with the aim of preventing formal coercive measures or of improving treatment adherence (8). It can range from persuasion or inducement to more distinct forms like threats (9). Szmukler and Appelbaum (10) divided informal coercion into hierarchical degrees of persuasion, interpersonal leverage, inducement, and threats. A study from 1998 (11) also revealed the demonstration of force as a relevant form of coercion. The authors grouped the forms of coercion into nine degrees: persuasion, inducement, threats, show of force, physical force, legal force, request for a dispositional preference, giving orders, and deception (11).

The important fact is the underestimation in particular of stronger forms of informal coercion and formal coercion (6, 7). Yet, health professionals with a positive attitude toward weaker forms of informal coercion, like persuasion or leverage, tend to underestimate its occurrence more than health professionals who disapprove its use. Correspondingly, inpatients perceive the attitudes of professionals and their interaction as the most important factors concerning coercive measures (12). In order to avoid coercive measures through de-escalation strategies, health professionals need to have specialized training and be aware not only of the use of informal coercion but also of the importance of a respectful and empathetic attitude and ward climate, a positive admission process, as well as debriefing strategies after coercive measures (12).

To balance the goals of the body-worn camera program with privacy concerns, officers will not record all interactions with the public. Officers must record certain events, including:

The purpose of body-worn cameras is to record enforcement, investigative and other encounters between the police and the public. They provide a contemporaneous, objective record of these encounters, facilitate review of events by supervisors, foster accountability, and encourage lawful and respectful interactions between the public and the police.

what are the 5 strategies for de-escalation?

Common to all theories of de-escalation is the prevention of aggression by intervening before it occurs and by calming the patient. The dominant controlling attitude to calming the patient in traditional understanding should be transformed into a collaborative endeavor, where individuals are encouraged to help themselves calm down by applying their own abilities and power (23). This requires a culture of empowerment of individuals. Such a culture should also involve the critical reflection of historically evolved rules, such as groups, which are not allowed to leave, or visiting hours, which could be individually arranged. In this context, practicing de-escalation for calming the psychiatric patient may also serve as an experimental learning opportunity for patient and staff. We propose a structured and commonly shared approach encompassing critical evaluations of historic courses of action, reflections, and discussions on personal experiences and attitude, and the use of informal coercion in order to facilitate the prevention and management of aggression and violence.

All officers equipped with body cameras have received training on how the cameras function, how to use the video management software, as well as the NYPD’s body camera policies. As part of their training, officers also, participate in role-play scenarios in order to acclimate themselves to the proper use of the cameras.

Does informal coercion impede the establishment of a therapeutic relationship? Or is persuasion or inducement one of these creative ideas to replace other de-escalation methods? The extent and the impact of applied informal coercion in therapeutic communication are often not recognized by practitioners, although they might interfere with a positive therapeutic relationship (6). Informal coercion is a frequently used form of communication to influence treatment outcomes. As a weaker form of coercion, it can be de-escalating if applied critically in a recovery-based environment. It needs to aim at reducing the use of seclusion and restraint and always requires moral justification and evaluation.

The NYPD will retain all video recordings for 18 months. Video of arrests and other significant incidents will be retained longer.

Health professionals may respond to aggression with de-escalation techniques, but a still predominant response to aggression and especially violence in psychiatric settings is a “physical” one. We have to think about which uses of measures in which situations of everyday life are really necessary, or could be replaced by other creative ideas or practices. Within these perspectives, we focus on a nursing approach, being aware that aggressive behavior affects the whole treatment team in mental health settings.

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In December 2017, Phase 2 of the body-worn camera rollout commenced equipping the balance of the officers on all shifts in every Precinct, Transit District and public housing Police Service Area citywide with cameras. This second phase was completed by March 2019 and resulted in more than 18,000 additional officers being equipped with cameras.

Body-worn cameras are small battery-powered digital video cameras that police officers attach to their uniform shirts or winter jackets. Officers must manually activate the record function on the camera to begin recording. The recording capabilities of the cameras are consistent with the capabilities of human eyes and ears. In other words, the cameras are not capable of any enhanced recording capabilities such as night vision. At the end of their shift, officers place their cameras in a docking station in their command. Once docked, recorded videos are uploaded to a cloud based storage solution and the camera’s battery is recharged automatically.

Information regarding the number of videos provided and their impact upon investigations may be found in the CCRB annual and semi-annual reports found here

Members of the public can request video under the Freedom of Information Law (FOIL). The NYPD will provide video in response to a FOIL request unless otherwise prohibited by law. The video may contain audio and/or visual redactions to protect the privacy of people captured in the videos, and other protected material pursuant to FOIL and other applicable laws.

The Department publicly releases body-worn camera video of critical incidents within 30 calendar days of an incident. In some cases, it may take more than 30 days if the investigation is complex, a court issues an order delaying or preventing release of the footage, or additional time is needed to allow a civilian depicted in the video, or their family, to view the video in advance. Critical incidents include the following:

De escalation techniquespdf

In constitutional countries, mentally ill people are the only human beings who can be detained without being accused of an offense. Compulsory measures are often based on aggressive behavior aiming to calm down a situation and the involved persons (1). Its use, though based on judicial and ethical principles or guidelines (see, for example, DGPPN 2018), negatively impacts attitude toward treatment and is always perceived as negative by patients (2). Patients reject compulsory measures more distinctly than health professionals and even more clearly if they have already experienced those measures and if they were admitted involuntarily (3). The most strongly rejected form of coercive measures for patients, relatives, and health professionals are net beds (which are not used any more in Switzerland), fixations, and seclusion (3). The use of either fixation or seclusion or both in psychiatric institutions is often determined by regional history and traditions of institutions and management and is currently being questioned in many European countries. Empirical evidence or definable indicators of the benefit or harm of applying coercive measures are rare. Psychiatric institutions with a psychiatric care contract are very often trapped between help and violence, the expectations of authorities and the public, as well as the expectations of the patients and their families or relatives.

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Health professionals like nurses respond to aggression and violence with de-escalation techniques, and still often with coercive measures. Such measures applied by institutions are often rooted in historically grown traditions rather than evidence, reflection, or formation. In this article, we present de-escalation strategies integrating a high and critical awareness toward traditions and the practice of formal and informal coercion.

The NYPD routinely provides the Civilian Complaint Review Board (CCRB) with body-worn camera video in furtherance of investigations of alleged incidents of misconduct under their jurisdiction. To facilitate more efficient sharing of videos, the NYPD and CCRB drafted a Memorandum of Understanding (MOU) regarding the protocols for the search, review, and production of relevant body-worn camera video for cases in which CCRB has received a complaint from a member of the public against a member of the NYPD. Implementation of this MOU is pending the establishment of a secure space within the CCRB facility. Video provided to CCRB may be redacted to protect confidential information or comply with relevant statutes including the sealed records laws (e.g. Criminal Procedure Law section 160.50 – 55) which generally prohibit the release of certain records absent a court order or consent of the individual(s) depicted

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All Police Officers, Detectives, Sergeants and Lieutenants regularly assigned to perform patrol duties throughout the city are equipped with body-worn cameras. The NYPD body-worn camera program is the largest in the United States with over 24,000 members of the Department equipped with body-worn cameras. The rollout of these cameras was conducted in three phases.

Phase 3 began in March 2019 – rolling out approximately 4,000 body-worn cameras to officers working in specialized units that perform patrol-oriented or support functions. Such units include the Emergency Services Unit, Highway Patrol, Strategic Response Group and Critical Response Command. The roll-out to specialty units was completed by August 2019. Additionally, the executives responsible for leading all of the commands equipped with body-worn cameras were also issued cameras during this phase.

Officers must tell members of the public that they are being recorded unless the notification would compromise the safety of any person or impede an investigation. Officers do not need a person’s permission to start, or to continue, recording.

If a video captures evidence related to a criminal case, the NYPD will turn the video over to the prosecutor with jurisdiction over the matter. Prosecutors will provide video to the defendant(s) in accordance with criminal discovery laws.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The aim of mental health practice should be to develop a high and critical awareness toward the use of coercive measures including informal coercion.

In April 2017, Phase 1 of the Department's body-worn camera program began, and by the end of 2017, approximately 1,300 police officers, working the evening shifts in 20 precincts across the city, were outfitted with cameras. This first phase supported a year-long study of the effects of the body-worn cameras.

The perception of coercion has been shown to never be neutral, but either positive or negative (22). Coercion can only be regarded as necessary when it immediately ensures integrity, autonomy, and safety of patients and staff. However, informal coercion can be seen as coercive in the sense that it still restricts patients’ voluntary and autonomous decisions. If the patient has a positive therapeutic relationship to the professional performing the coercion, he more readily perceives the coercion itself as morally right and accepts more pressure than if a stranger performed it (22). It is easier to “take advice” from someone you trust.

In Germany and Switzerland, one concept is the ProDeMa® that provides a practical guideline for healthcare professionals to deal with aggression (19). The guideline aims to convey de-escalation interventions and to develop a professional approach. As in the “Six Core Strategies,” there are different steps of de-escalation. The first step, the prevention of aggression, involves getting in contact with or gaining the attention of a certain person. ProDeMa® emphasizes that without contact, de-escalation may not occur. Getting in contact is linked to asking about the wishes and needs of the person. The second stage intends to change one’s own perspectives of aggressive behavior before reacting, while during the third phase, an understanding of the causes is developed. The art is not to ask “why” but, for example, “what would help.” The next two steps deal with verbal and nonverbal de-escalation techniques to calm down a person and to master a difficult situation. Nonverbal de-escalation, for example, comprises the protection of the own person. The last stage describes least restrictive and patient-friendly holding techniques, immobilization, or, in some hospitals, fixation.

Additionally, the Department may release other extrinsic evidence along with any relevant body-worn camera video if it may provide context for the incident and assist the viewer in understanding what lead up to the event as well as what transpired during the event. Video may be redacted (e.g., faces of civilian witnesses and bystanders blurred, etc.), as appropriate, to protect personal privacy and comply with all relevant laws, prior to being released to the public. Unedited video of a critical incident will be maintained, and provided to an appropriate investigating authority (e.g. District Attorney, etc.).

Officers may not record certain sensitive encounters, such as speaking with a confidential informant, interviewing a sex crime victim, or conducting a strip search.

The use of body-worn cameras has shown that cameras may help de-escalate potentially volatile encounters. The cameras may also provide important evidence in criminal and civil proceedings as well as resolving civilian complaints.

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