Ron Diamond’s slide sets will be available on the TheMHS website:
www.themhs.org
Ron argued that often traditional goals centre around eliminating violence through sedation, seclusion and restraint. Ron argues that a more modern way is to solve the problem without violence, placing the use of medication in the emergency department as one of many tools, the use of which should be framed in terms of starting or enhancing the therapeutic relationship, rather than a blunt instrument for reducing risk. Medication should facilitate an ongoing conversation about how the consumer can maintain or regain control, rather than medication being “the end of the conversation”.
Ron argues for 5 fundamentals in an effective response to violence in emergency departments: preparation, rapid and safe engagement, being authoritative and clear, deescalation and connection, and orientating all responses to treatment (see his slides at www.themhs.org – to be updated soon).
He emphasised the importance of ongoing questioning, asking yourself “why is this person becoming agitated?” Seeking to understand first, acting second: “Have a seat, talk, I’ll listen”. The context of violence and agitation is important: “How does this episode fit into the story of the person’s life?” Ron asks us to remember that people end up in the emergency department in crisis because some part of their life is falling apart, not just because they are “more ill”. He argues that if you can figure out why the patient has come into emergency you will be far better resourced when attempting to resolve the situation. Ron also emphasises the importance of involving consumers in every stage of their care, including the choice and dose of medications.
The key question arising from Ron’s talk was this: why am I using medication? What is the endpoint? Is it to facilitate further dialogue with the consumer and their family or to end the conversation?
