The approach and guidance presented on this website have been supported by a number of key stakeholders.

“The challenge of keeping patients safe at times when they are outwardly exhibiting challenging behaviour has been increasingly recognised over the last few years. ‘Meeting needs and reducing distress’ provides a welcome focus on an area of healthcare that can cause high levels of anxiety for patients, their families and healthcare professionals.“This is part of a wide and far-reaching programme of work being developed on the avoidance and safe management of restraint, to ensure every step is taken to keep risk to a minimum and that safety is paramount.”

Dr Mike Durkin, Director of Patient Safety, NHS England

 rcn “This is important and welcome guidance, which should help with this difficult problem which we know affects many nursing staff. Challenging behaviour can manifest in many ways and can sometimes result in physical harm to the member of staff or patients. Whether they work in hospitals, care homes, or mental health services, staff need to be supported to work in an environment which is safe for them, and safe for all their patients. This guidance should make it easier to prevent and manage challenging behaviour while maintaining the needs and dignity of the patient. We would urge employers to ensure that this guidance can be implemented and care delivered safely.”

Dr Peter Carter, Chief Executive & General Secretary of the Royal College of Nursing

rcpy “Challenging behaviours are one of the most distressing and stressful situations for healthcare professionals to manage. This is a really helpful, comprehensive and readable guide to help all health professionals recognise, understand and manage challenging behaviour.”

Dr James Warner, Chair of Old Age Faculty, Royal College of Psychiatrists

 rcp “On a day-to-day basis, healthcare staff will face a variety of challenging situations, including patients whose behaviour can sometimes make it difficult for staff to give their best care.  This new resource will help by providing strategies for prevention and management of these situations, and the practical examples and case studies will help doctors apply these to their own practice.”

Dr Anita Donley, Clinical Vice-President, Royal College of Physicians

 cem “Challenging behaviours commonly occur in Emergency Departments; providing high quality care for patients exhibiting these is important. The College of Emergency Medicine welcomes this national guidance in the hope that we can continue to improve the care we provide for patients.”

Dr Simon Smith, Chair, College of Emergency Medicine Best Practice subcommittee

cot “The College of Occupational Therapists supports this document as it highlights how occupational therapists can reduce challenging behaviour by ensuring access to meaningful activity and sensory integration where appropriate. It recognises the importance of a partnership approach between allied health professions, nurses and doctors and has been developed with patients’ needs firmly at its heart. I urge all occupational therapists to familiarise themselves with this important guidance.”

Genevieve Smyth, Professional Affairs Officer for Mental Health and Learning Disabilities, College of Occupational Therapists

mind “Mental health services can be challenging environments and health providers need to ensure the safety of patients and staff. The culture and environment of wards can act as a trigger for challenging behaviour but treating people with dignity and respect, listening to them and providing activities, therapies and access to outdoor space will help recovery and prevent challenging situations. Training staff in de-escalation techniques can help them manage challenging situations and support the recovery of people in crisis.

“We welcome this guidance, which is based on fundamental principles of understanding the causes of challenging behaviour, communication and patient-involvement.”

Paul Farmer, Chief Executive at Mind, the mental health charity

 cbf “It is essential that people with learning disabilities who display behaviour described as challenging access appropriate healthcare. The CBF welcomes the publication of this guidance, which focuses on meeting needs and aims to improve the safety and wellbeing of patients who display challenging behaviour. We look forward to the guidance being put into practice, and delivering better outcomes for all.”

Viv Cooper, Chief Executive, The Challenging Behaviour Foundation

 bgs “The British Geriatrics Society welcomes this document, which is an important step forward for the safety of patients with challenging behaviour. Of particular importance is the way that it places the understanding of challenging behaviour, and non-pharmacological strategies driven by this understanding, at the forefront of management. Its recommendations on staff training will be useful for any NHS organisation that takes management of challenging behaviour seriously.”

The British Geriatrics Society

 bildweb “We are pleased to be able to contribute to the thinking behind this important document. Providing the right support for people whose behaviour is described as challenging demands that we create a culture that fosters compassionate care, that all incidents are reported and learnt from, and that we continually strive to improve staff practice at every level, in every setting. If we work together, we can get this right.”

Ann Chivers, Chief Executive, British Institute of Learning Disabilities


“The issue of safe care and effective management of clinically related challenging behaviour must be given high priority. This guidance from NHS Protect is useful and applicable to a range of settings, and we plan to use it in upcoming training sessions relating to dementia care. The guidance will assist with implementing clear, consistent and evidence-based responses and skilled interventions to manage challenging behaviour; embedding reflective practice; and providing incentives rather than punitive measures for staff and services to develop new ways of dealing with challenging behaviour based on increased knowledge, skills and confidence. Joint working and sharing of information will always be paramount to ensuring good outcomes. Clinicians, particularly practising nurses, should be encouraged to research, write and publish new and effective approaches.”

George Coxon, Chair, Unite the Union Mental Health Nursing Association (MHNA)


“The National Association for Healthcare Security is delighted to have been involved with the development of this new guidance.  The need to prevent and manage clinically related challenging behaviour in the NHS has never been greater and we thoroughly welcome this guidance that we believe will go some considerable way to prevent or reduce acts of violence towards our staff while ensuring the safety and quality of care of our patients”.

Peter Finch, Chair, National Association for Healthcare Security