rd_small111When patients and service users are distressed, anxious, frightened, ignored, or unable to tell someone what they need, they may display challenging behaviour. This is particularly the case where their clinical condition is linked to some form of cognitive impairment and/or communication difficulty that may cause them to be predisposed to distress or unable to express themselves verbally.

Clinically related challenging behaviour is common yet underreported across healthcare settings. If not adequately addressed, challenging behaviour can impair the ability of staff to deliver high-quality, appropriate care. It can also lead to an over-reliance on restrictive physical and pharmacological interventions, psychological ill health and physical injuries among staff and patients. At an organisational level, a failure to adequately manage challenging behaviour can be harmful to the organisation’s reputation and/or detrimental financially (e.g. through sickness absence).

This website is designed to share the knowledge, strategies, and good practice gathered as part of a long-term project managed by NHS Protect together with a clinically led Expert Group. It is designed as a reference point for managers, staff, patients and carers to access guidance and best practice and to share their own experiences in preventing and managing challenging behaviour.

A unique feature of the guidance and recommended strategies provided here is that they are designed to apply to any patient or service user group in any healthcare setting. They are intended to help staff identify, recognise, analyse, prevent, manage and share information about clinically related challenging behaviour.

The aim of this work is ultimately to assist staff in meeting needs and reducing distress by the delivery of high-quality, individualised care.

When things go wrong

The events at Mid Staffordshire Hospital and Winterbourne View Hospital illustrate only too clearly what can go wrong when poor standards of care and a culture which condones them are not addressed. These events had serious repercussions for patient/service user safety and wellbeing, perpetuating their distress and vulnerability and increasing the likelihood of challenging behaviour. In many cases staff failed in their duty of care; and the organisations tolerated poor practice while failing to be accountable for the quality care.