Breakaways in specialist secure psychiatry

Violent and aggressive behaviour towards clinical staff poses a serious problem in inpatient forensic services for men, women (Nicholls et al. 2009) and adolescents (McDougall 2000), and in inpatient acquired brain injury (Alderman 2007) and geriatric units (Almvik et al. 2006). The National Institute for Mental Health in England (2005) recommends that staff who are exposed to violence and aggression should be trained in ‘breakaway’ techniques (‘breakaways’): ‘a set of physical skills to help separate or breakaway from an aggressor in a safe manner . . . [that] do not involve the use of restraint’. Previous studies have raised concerns about content and delivery of breakaway training (Rogers et al. 2007) and about its effectiveness in terms of translation into practice (Rogers et al. 2006, 2007, Dickens et al. 2009). Previous large-scale surveys of nursing and other clinical staff about their use of breakaway techniques have been conducted in acute psychiatric settings (Wright et al. 2005) and results may not generalize to specialist forensic and other secure services. Studies of inpatient violence that include data from secure services (Royal College of Psychiatrists 2005) lack detail about the use of breakaway techniques specifically. In order to inform training developments in our service, we conducted a study to describe the use of breakaways among registered mental health and learning disability nurses (RNs), healthcare assistants (HCAs) and other multidisciplinary clinical staff (‘other staff’) in a large specialist secure psychiatric hospital.