What is De-escalation?
In mental health practice, de-escalation means using calm, respectful, and therapeutic communication and behaviour to reduce a person’s agitation, anger, or distress before it escalates into aggression or harm.
It is about:
Preventing conflict from getting worse
Promoting safety for the person, staff, and others
Building trust and rapport so the person feels heard and respected
It is a core skill in the NMC OSCE (Mental Health) and in everyday nursing practice.
Key Features of De-escalation
- Non-threatening body language (open posture, safe distance)
- Calm voice (soft tone, slow pace, low volume)
- Active listening and empathy
- Using open-ended questions
- Acknowledging feelings and validating concerns
- Offering reassurance or solutions where possible
- Distraction or redirection (based on person’s interests)
- Keeping yourself and environment safe
Scenario 1:
You are a nurse on a mental health ward. A patient, Mr. A, is pacing the room, raising his voice, and appears frustrated because he believes staff are not listening to him. You are asked to de-escalate the situation.
Step-by-Step Approach according to NMC marking criteria
Gains consent before entering the room.
Knock on the door gently, pause, and say:
“Hello Mr. A, it’s [your name], one of the nurses here. Is it okay if I come in and talk with you?”
Considers environment safety.
Before entering, look around the room: check exits are clear, ensure no sharps or potential weapons are nearby, and position yourself so you have a safe exit route.
Introduces self.
“My name is [your name], and I’m one of the nurses looking after you today.”
Non-threatening body language.
Stand with relaxed shoulders, open palms, avoid crossing arms, and keep a safe distance (about 1–2 metres).
Calm speech.
(In a gentle voice) “I can see you’re upset right now, and I want to understand what’s going on for you.”
Eye level and eye contact.
Sit down if the patient is seated, or slightly lower your posture. Maintain natural eye contact without staring.
Allow concerns, show empathy.
Pause and listen actively. After the patient vents frustration, respond empathetically:
“It sounds like you’re feeling ignored and that’s very frustrating. I can understand why that would upset you.”
Open-ended questions.
“Can you tell me more about what’s making you feel this way?”
Active listening and validation.
Nod, paraphrase what they say:
“So, you feel staff haven’t explained what’s happening clearly, and that makes you anxious?”
Answer questions if able.
“I don’t have all the answers right now, but what I can do is find out when the doctor will be available to speak with you.”
Repetition as needed.
“Just to make sure I’ve got this right—you’re worried about not knowing what will happen next, and that’s making you feel upset?”
Distraction technique.
“I remember you mentioned you enjoy music. Would you like me to get your headphones so you can listen while we sort this out?”
Recap before ending.
“So today we’ve talked about how you’re feeling frustrated, and I’ve promised to check when the doctor will see you. We also agreed I’ll bring you your headphones.”
End intervention appropriately.
“Thank you for sharing this with me, Mr. A. I’ll come back shortly with an update. For now, try to take some deep breaths and settle. Is there anything else you’d like before I go?”
Professional behaviour (NMC Code).
Throughout, remain respectful, compassionate, non-judgmental, and ensure the patient’s dignity and safety are prioritised.
Scenario 2:
You are a nurse on an acute mental health ward. A patient, Ms. B, is sitting in the day room. She appears distressed, muttering angrily that staff are keeping her “locked up unfairly.” She is tapping her foot rapidly and clenching her fists.
Step-by-Step Approach according to NMC marking criteria
Gain consent before entering room.
Knock gently on the doorframe and speak softly:
“Hello Ms. B, it’s [your name], one of the nurses. Is it okay if I come and sit with you for a few minutes?”
Check safety of environment.
Quickly scan the room: ensure no sharp objects or potential hazards, position yourself close to the exit, and keep safe personal space (arm’s length).
Introduce self.
“My name is [your name]. I’m here to support you.”
Non-threatening body language.
Sit down slightly angled, hands relaxed on your lap, no sudden movements, calm facial expression.
Use calm, kind voice.
“I can see you’re upset, and I’d really like to understand what’s going on for you.”
Stay at eye level.
If Ms. B is sitting, sit too (not standing over her). Maintain natural eye contact, glance away at times to avoid staring.
Allow her to share, show empathy.
After listening:
“It sounds like you’re feeling trapped and unheard, and that must feel very overwhelming.”
Use open-ended questions.
“What do you feel would help you most right now?”
Active listening and validation.
“I hear that you feel this is unfair. That must be very frustrating for you. You want to be trusted more.”
Offer answers if possible.
“The team’s decision is based on keeping you safe, but I can explain what the plan is for today if that would help.”
Repeat key points.
“So you’re saying you feel frustrated because you don’t have much choice in your care?”
Distraction technique.
“I remember you like drawing. Would you like me to bring you some art supplies while we talk?”
Recap before ending.
“So we’ve talked about how you feel locked in and frustrated. I’ve explained today’s care plan, and I’ll get you some drawing materials to help you relax.”
End intervention appropriately.
“Thank you for telling me how you’re feeling, Ms. B. I’ll check in with you again shortly. You’re not alone—we’re here to support you.”
Professional behaviour.
Throughout: remain compassionate, non-judgmental, therapeutic, and consistent with NMC Code (2018).
