Conflict Resolution and De-escalation
Document control
Document owner: Registered Manager
Clinical approval: Nominated Individual
Version: 2.0
Approval date: [INSERT DATE]
Review date: 01 January 2027
Training renewal: Annually
Applicable staff: WMI Psychiatry administration staff
Training level: Awareness level and role-proportionate
Estimated completion time: 45–60 minutes
Assessment: 15 multiple-choice questions
Pass mark: 80%
Safety-critical questions: All must be reviewed if answered incorrectly
This module must also be reviewed following:
a violent or aggressive incident
a serious threat towards a patient or staff member
evidence that staff did not feel able to summon help
a significant change to WMI Psychiatry’s premises or working arrangements
a change to the local emergency procedure
identification of a recurring conflict or safety concern
an adverse finding by CQC or another relevant organisation
a significant change to national guidance
Related WMI Psychiatry documents
This module should be read alongside:
Conflict Resolution and De-escalation Policy
Health and Safety Policy
Lone Working Policy
Incident Reporting Policy
Complaints Policy
Safeguarding Children Policy
Safeguarding Adults Policy
Unacceptable Behaviour Policy
Equality, Diversity and Human Rights Policy
Information Governance and Confidentiality Policy
Emergency Response Procedure
Business Continuity Policy
Staff Code of Conduct
Salford Innovation Forum site procedures
relevant risk assessments
1. Purpose and training rationale
Most communication with patients and families is respectful and constructive. There may be occasions when someone becomes upset, frustrated, angry or threatening. Conflict may arise during telephone calls, emails, video appointments or face-to-face contact.
Administration staff are often the first point of contact. Their communication can help prevent a disagreement from escalating and can help the person feel heard. Staff must also recognise when attempts at de-escalation are no longer safe and when they should withdraw, end the contact or summon help.
Conflict does not always involve aggression. It may involve:
a disagreement about an appointment
dissatisfaction about a fee
different expectations about a service
frustration about a delayed response
confusion about an administrative process
disagreement between family members
disagreement between colleagues
concern about a clinic decision
a misunderstanding caused by unclear communication
Aggression may include:
shouting
swearing directed at another person
insults
intimidation
repeated hostile messages
threats
discriminatory abuse
unwanted sexual comments
invading someone’s personal space
damaging property
blocking an exit
attempting to strike someone
physical assault
The Health and Safety Executive defines work-related violence as an incident in which a person is abused, threatened or assaulted in circumstances connected with their work. This includes verbal abuse and threats as well as physical attacks. Employers must assess and manage foreseeable risks. Staff should receive training which reflects their role and the risks associated with their work. HSE guidance on violence and aggression at work
WMI Psychiatry provides outpatient services. Administration staff are not employed to manage high-risk behavioural emergencies or provide physical intervention. Their responsibilities are to:
communicate calmly
recognise early warning signs
reduce avoidable sources of conflict
maintain professional boundaries
offer realistic options
protect personal safety
obtain assistance
end unsafe contact
report incidents
support organisational learning
This module does not:
qualify staff to use restraint
authorise physical intervention
replace practical safety training where this is required by a risk assessment
require staff to remain in an unsafe situation
authorise administrators to conduct clinical risk assessments
authorise administrators to make clinical decisions
replace safeguarding procedures
replace emergency services
require staff to tolerate abuse, threats or harassment
permit staff to disclose confidential information to calm a situation
2. Learning outcomes
By the end of this module staff should be able to:
Explain the difference between conflict, distress, aggression and violence.
Identify common causes of conflict in an outpatient service.
Recognise early signs that a situation may be escalating.
Use verbal and non-verbal communication to reduce tension.
Listen actively and acknowledge another person’s experience.
Set clear and respectful boundaries.
Offer realistic choices without making unauthorised promises.
Respond appropriately during telephone, email, video and face-to-face contact.
Recognise when de-escalation is not working.
Prioritise personal safety and the safety of others.
Summon assistance and follow emergency procedures.
Understand that administration staff must not use restraint or physical intervention.
Respond appropriately to discriminatory, abusive or threatening behaviour.
Record and report incidents accurately.
Contribute to post-incident support, reflection and learning.
3. WMI Psychiatry local contacts and procedures
These details must be completed before the module is issued.
Internal escalation
Registered Manager: Caroline Lawrence
Contact method: [INSERT CONTACT METHOD]
Nominated Individual: Dr James Glass
Contact method: [INSERT CONTACT METHOD]
Responsible clinician or duty clinician: [INSERT CONTACT METHOD]
Safeguarding lead: [INSERT NAME AND CONTACT METHOD]
Deputy safeguarding lead: [INSERT NAME AND CONTACT METHOD]
Health and safety lead: [INSERT NAME AND CONTACT METHOD]
Incident reporting system: [INSERT SYSTEM OR LOCATION]
Location of relevant risk assessments: [INSERT LOCATION]
Salford Innovation Forum
Centre Manager or Reception Team contact: [INSERT DETAILS]
Method for summoning immediate assistance: [INSERT DETAILS]
Location of staff exits: [INSERT DETAILS]
Location and operation of any alarm: [INSERT DETAILS]
Emergency assembly arrangements: [INSERT DETAILS]
Procedure for notifying site reception of a concerning visitor: [INSERT DETAILS]
Remote working
Method for obtaining management support: [INSERT DETAILS]
Lone-working check-in procedure: [INSERT DETAILS]
Procedure for escalating threatening emails or calls: [INSERT DETAILS]
Procedure for protecting personal contact details: [INSERT DETAILS]
Emergency services
Call 999 when there is an immediate threat to life, serious violence, a weapon or another emergency requiring an urgent police or ambulance response.
Staff must know the address of the location from which they are calling.
Do not assume that another person has contacted emergency services. Confirm who is making the call.
4. Understanding conflict
Conflict occurs when people believe that their needs, expectations, rights or priorities are incompatible.
Conflict can arise even when nobody intends to cause difficulty. For example:
a parent expects an immediate response but the clinician is unavailable
a patient believes a service was included within a fee when it was not
an appointment time has been misunderstood
a report contains information the patient disputes
a family wants information which cannot be shared without consent
a staff member follows a policy which the person considers unfair
a patient needs an adjustment which was not anticipated
a person has received inconsistent information from different staff members
Conflict is not automatically misconduct. A person can disagree firmly or make a complaint without being abusive.
Staff should not describe someone as aggressive simply because they:
ask several questions
challenge a decision
request an explanation
make a complaint
become tearful
communicate directly
speak loudly because of a hearing difficulty
avoid eye contact
move repetitively
need additional processing time
become overwhelmed by uncertainty
ask for a reasonable adjustment
Staff should focus on observable behaviour rather than assumptions about the person’s intention.
For example:
Objective description:
“The caller raised their voice and repeatedly spoke over me after I explained that the appointment could not be moved to the requested time.”
Unhelpful description:
“The caller was difficult and manipulative.”
5. Why conflict may escalate
A disagreement may escalate when a person feels:
ignored
misunderstood
judged
blamed
embarrassed
frightened
powerless
rushed
confused
treated inconsistently
unable to access information
concerned about their child
worried about medication
anxious about cost
uncertain about what will happen next
Environmental and organisational factors can also increase tension. These include:
long waits
unclear fees
unanswered messages
conflicting information
lack of privacy
noisy or crowded areas
inaccessible communication
unexpected changes
poor signage
cancelled appointments
failure to provide an agreed adjustment
uncertainty about who is responsible
staff appearing rushed or dismissive
HSE advises employers to consider how the design of work and communication with the public may trigger aggression. Clear information about delays or problems can reduce avoidable conflict. HSE control measures
Not every escalation can be prevented. Staff are not responsible for another person’s decision to threaten or harm them. Good communication reduces some risks but does not guarantee safety.
6. Distress, neurodivergence and communication differences
WMI Psychiatry works with people who may be distressed, anxious, autistic, have ADHD or have other communication needs.
A person who is overwhelmed may:
speak more loudly
repeat the same question
find it difficult to process explanations
struggle to identify what they need
become distressed by uncertainty
need more time to respond
avoid eye contact
pace or move repetitively
find a noisy environment difficult
interpret language literally
become frustrated when plans change
communicate more effectively in writing
These behaviours do not automatically indicate aggression.
Helpful adjustments may include:
reducing background noise
using clear and literal language
providing one piece of information at a time
allowing processing time
writing down the next steps
avoiding unnecessary changes
explaining how long something is likely to take
offering email rather than telephone communication
allowing a trusted person to support communication where appropriate
checking whether the person has understood
asking what would help
Do not make assumptions based on a diagnosis. Ask the individual what support they need.
Reasonable adjustments do not require staff to accept threats, harassment or violence. Safety boundaries still apply.
7. Early warning signs
Possible warning signs include:
a noticeable change in tone or volume
increasingly rapid speech
repeated interruption
hostile or insulting language
clenched fists
jaw tension
pacing
agitated movements
staring or glaring
invading personal space
blocking a doorway
pointing aggressively
striking furniture
throwing objects
repeated demands for an immediate decision
statements suggesting retaliation
threats towards a person, property or the clinic
references to weapons
refusal to allow the conversation to end
attempts to follow a staff member into a restricted area
threats to locate a staff member outside work
A single sign does not prove that violence will occur. Staff should consider the overall situation and any change from the person’s previous behaviour.
Trust your judgement. If a situation feels unsafe you may:
create distance
move towards a safe exit
alert another staff member
contact the Centre Manager or Reception Team
use the agreed alarm
end the call
leave the area
follow the emergency procedure
call 999 where required
You do not need to wait for physical violence before seeking help.
8. The CALM approach
Use the CALM approach where it is safe to continue.
C – Create safety
maintain access to an exit
allow personal space
reduce the number of people involved
move bystanders away where possible
remove avoidable noise or stimulation
alert a colleague early
keep your hands visible
avoid sudden movements
do not stand over the person
do not allow yourself to become trapped
A – Acknowledge and assess
listen to the main concern
acknowledge the person’s feelings
identify what they need
check for immediate threats or safety concerns
consider whether a communication adjustment may help
notice whether the person is becoming calmer or more agitated
L – Limit and offer choices
explain what you can do
explain what you cannot do
set respectful boundaries
offer realistic options
avoid making promises outside your authority
provide a clear next step
involve a manager where appropriate
M – Move to safety and report
end the interaction if it remains unsafe
obtain assistance
follow the emergency procedure
contact emergency services when required
preserve relevant evidence
report the incident
seek support after the event
The CALM approach is a memory aid. It does not replace professional judgement or WMI Psychiatry’s emergency procedures.
9. Verbal de-escalation
HSE recommends using a clear calm voice, maintaining personal space, showing that you are listening, avoiding arguments and offering realistic alternatives. If the situation remains unsafe staff should follow the emergency procedure. HSE de-escalation guidance
Speak calmly
Use a steady pace and moderate volume.
Avoid:
shouting over the person
speaking sarcastically
issuing unnecessary commands
using patronising language
matching the person’s anger
speaking very quickly
making several points at once
Helpful wording includes:
“I would like to understand what has happened.”
“I can hear that this has been frustrating.”
“Let us take one point at a time.”
“I cannot make that decision myself but I can ask the appropriate person to review it.”
“I will explain the options that are available.”
Listen actively
Active listening involves:
allowing the person to explain
not interrupting unnecessarily
identifying the main issue
reflecting back what you have understood
checking whether your summary is accurate
recognising the effect the situation has had
For example:
“My understanding is that you expected the prescription to be ready today and you were not told there would be a delay. Is that correct?”
Listening does not mean agreeing that every allegation is correct. It shows that the concern has been heard.
Acknowledge feelings without endorsing harmful behaviour
You can acknowledge distress while maintaining a boundary.
For example:
“I understand that you are angry about the delay. I want to help but I cannot continue the call while I am being threatened.”
Avoid statements such as:
“Calm down.”
“You are overreacting.”
“There is nothing to be angry about.”
“That is not my problem.”
“You always do this.”
“If you had listened properly this would not have happened.”
“Everyone else understands the process.”
Use clear language
Explain:
what has happened where known
what you can do now
who needs to make the decision
when the person can expect an update
what they can do if they remain dissatisfied
Do not use vague reassurance such as:
“I am sure it will be sorted soon.”
Instead say:
“I will send this to the Registered Manager today. We will update you by [REALISTIC DATE OR TIME].”
Offer choices
Choices can help restore a sense of control.
For example:
“I can ask the clinician to review the request or I can explain how to make a formal complaint.”
“We can continue by email or I can arrange for a manager to call you.”
“Would you prefer to wait in reception or return at the agreed appointment time?”
Only offer options which are safe and available.
10. Non-verbal communication
During face-to-face contact:
maintain a calm expression
use an open posture
keep your hands visible
allow personal space
avoid pointing
avoid staring
avoid crowding the person
do not touch the person
avoid sudden movements
stand at an angle rather than directly confronting them
maintain awareness of the exit
avoid folding your arms in a confrontational way
keep your voice controlled
Eye contact should be appropriate to the individual and situation. Do not insist that a person makes eye contact. Some people find direct eye contact uncomfortable or overwhelming.
If the person moves closer:
step back where safe
preserve access to an exit
state the boundary clearly
seek help if they do not respect the boundary
For example:
“I need you to give me some space. I will continue speaking with you from here.”
11. Setting boundaries
De-escalation is not the same as agreeing to every demand.
A clear boundary should state:
the behaviour which needs to change
what is required
what will happen if the behaviour continues
For example:
“I want to help with your appointment. I need you to stop swearing at me. If the swearing continues I will end the call and ask a manager to contact you.”
For a threat:
“I cannot continue the call while threats are being made. I am ending the call now and will report what has been said.”
For repeated interruption:
“I would like to understand each concern. I need us to speak one at a time. If that is not possible we can continue by email.”
For discriminatory abuse:
“That language is not acceptable. If it continues I will end the conversation.”
Boundaries should be:
calm
clear
proportionate
realistic
consistently applied
compatible with the person’s communication needs
Do not give a warning which you are unable or unwilling to follow.
A warning is not required before ending contact when there is an immediate threat or serious abuse.
12. When de-escalation is not working
Signs that de-escalation may not be working include:
the person becomes increasingly threatening
the person refuses to respect physical space
an exit is blocked
objects are thrown
property is damaged
a weapon is seen or mentioned
the person attempts to enter a restricted area
threats become specific
the person appears to be preparing to assault someone
other patients or children are at risk
the staff member feels unable to continue safely
At this point the priority changes from resolving the disagreement to protecting safety.
Staff should:
stop trying to resolve the administrative issue
create distance where possible
move towards a safe exit
summon assistance
direct other people away from danger
leave the area where safe
call 999 where there is an immediate danger
follow the local emergency procedure
record and report the incident
Do not remain in danger because you are worried about appearing impolite.
Do not attempt to retrieve clinic property if doing so would increase the risk.
13. Physical intervention and restraint
Administration staff must not:
restrain a patient or visitor
attempt to remove a weapon
block an aggressive person’s exit
physically escort someone from the premises
use pain to obtain compliance
pursue a person who leaves
place themselves between two people who are fighting
attempt to protect property by confronting an aggressive person
use unauthorised physical intervention techniques
Move away and obtain assistance.
If an immediate instinctive action is needed to escape an assault staff should use the minimum action needed to reach safety. This module does not teach or authorise restraint.
Any physical contact connected with an incident must be reported and reviewed.
14. Face-to-face incidents
Before the working day:
know the emergency exit arrangements
know how to contact the Reception Team or Centre Manager
know how to summon help
keep staff-only areas secure
avoid leaving confidential records visible
report faults affecting doors, alarms or communication systems
review relevant information provided through authorised systems
follow lone-working arrangements
During a concerning interaction:
remain near an exit
avoid allowing the person between you and the exit
do not invite an agitated person into an isolated room
alert another staff member early
move other patients away where possible
use calm and simple language
avoid having several staff members speak at once
do not touch the person
end the interaction if safety cannot be maintained
Where several staff members are present one person should normally lead the communication. Other staff should support safety and avoid arguing with the person.
After the person leaves:
do not follow them
secure the area where appropriate
check whether anyone needs medical attention
notify site staff
preserve evidence
report the incident
record any continuing threat
15. Telephone de-escalation
Telephone conflict may escalate because visual information is absent and either person may misunderstand the other’s tone.
Helpful actions include:
identify yourself and your role
speak slowly and clearly
allow the caller to explain
summarise the main concern
separate several concerns into manageable points
explain what action you can take
give realistic timescales
avoid repeatedly transferring an angry caller
obtain support from a manager
document agreed next steps
If the caller becomes abusive:
“I would like to help. I need you to stop using abusive language so that we can continue.”
If the behaviour continues:
“I have explained the standard of communication required. I am ending the call now. I will report your concerns and the content of this call to my manager.”
End the call immediately if:
a serious threat is made
the caller makes discriminatory or sexual abuse which makes continued contact unsafe
the caller states they are coming to harm someone
the caller repeatedly refuses to allow the conversation to continue safely
continuing the call places staff at further risk
Record the person’s words as accurately as possible. Do not embellish or minimise them.
If the caller makes a specific threat:
note the telephone number where available
note the date and time
note the exact words
note any named person, location, weapon or intended time
notify the Registered Manager immediately
contact the police through 999 if the threat appears immediate
preserve any voicemail
Do not place yourself at risk by attempting to keep a threatening caller talking unless emergency services specifically advise this.
16. Email, messaging and online abuse
Written communication may include:
repeated hostile emails
threats
discriminatory abuse
sexual harassment
attempts to identify a staff member’s home address
threats to publish personal information
threatening social media posts
excessive contact which disrupts the service
Staff should:
preserve the original communication
avoid responding while upset
notify the Registered Manager
use an approved response where appropriate
maintain confidentiality
follow the incident procedure
follow the data breach procedure if personal information is involved
contact the police when directed or when there is an immediate threat
avoid using personal accounts to investigate the person
Do not delete threatening messages.
Do not engage in an argument by email.
A response may state:
“We have received your message and recorded your concerns. Threatening or abusive communication towards staff is not acceptable. Your concerns will be reviewed through the appropriate process. Future communication must remain respectful.”
Any restriction on communication should be authorised, proportionate and documented. Arrangements should still allow legitimate clinical or administrative information to be communicated safely.
17. Video appointments and remote contact
Before a video interaction:
use the approved platform
protect personal contact information
know how to end the session
know how to contact a manager
confirm how urgent concerns should be escalated
avoid displaying personal information in the background
If a person becomes verbally aggressive:
speak calmly
state the boundary
offer to continue when communication is respectful
end the call if the behaviour continues
notify the relevant clinician or manager
record the incident
If the person makes an immediate threat towards themselves or another person:
establish their location where possible
alert the responsible clinician
follow the emergency procedure
contact emergency services where required
do not attempt to conduct a clinical assessment unless this is part of your professional role
Ending the video connection does not remove the need to act on an immediate safety concern.
18. Conflict between patients or family members
Staff may witness disagreement between:
parents
a parent and young person
separated family members
a patient and accompanying adult
two people in a waiting area
Administration staff should not attempt to decide who is right.
Where it is safe:
speak calmly
ask people to lower their voices
separate conversations where this can be done without physical intervention
move other patients away
notify a clinician or manager
protect confidential information
consider whether a child or vulnerable person may be at risk
If violence or an immediate threat occurs:
move to safety
summon help
call 999 where required
follow safeguarding procedures
complete an incident report
Do not physically stand between people who are fighting.
A disagreement between family members may reveal a safeguarding concern. De-escalation does not replace safeguarding action.
19. Conflict between colleagues
Conflict may also occur within the staff team.
Examples include:
disagreement about responsibilities
frustration about workload
unclear communication
inconsistent procedures
concern about another person’s conduct
feedback being delivered in an unhelpful way
disagreement about how an incident was managed
Staff should:
address concerns privately where appropriate
focus on the specific issue
use factual examples
listen to the other person’s perspective
avoid personal criticism
agree clear actions
seek management support where the matter cannot be resolved
use the appropriate grievance, whistleblowing or safeguarding procedure where required
Useful wording includes:
“When the message was not passed to the clinician the family did not receive an update. Can we agree how urgent messages will be recorded in future?”
Avoid:
“You never do anything properly.”
Bullying, harassment, discrimination, threats or violence are not ordinary differences of opinion and should be reported through the appropriate procedure.
Patient safety concerns must not be left unresolved simply to avoid conflict.
20. Discriminatory abuse and harassment
Discriminatory abuse may relate to:
race
religion or belief
disability
sex
sexual orientation
gender reassignment
age
pregnancy or maternity
marriage or civil partnership
another personal characteristic
It may be directed at a staff member, patient or visitor.
Staff should:
state that the language or behaviour is unacceptable
end the interaction if it continues
obtain assistance
preserve written or recorded evidence
report the incident
seek support
consider whether another person has also been harmed or placed at risk
Do not excuse discriminatory abuse because the person is distressed.
Do not expect the staff member who was targeted to continue managing the interaction.
The underlying clinical or administrative need should still be considered through a safe alternative arrangement where appropriate.
21. Complaints and conflict
A person has the right to complain. Making a complaint is not aggressive behaviour.
If someone states they want to complain:
acknowledge this
listen to the main concerns
explain the complaints process
record the complaint
pass it to the complaints lead
check for immediate safety concerns
maintain confidentiality
Do not:
tell them that complaining will affect their care
describe the complaint as abusive simply because it is critical
pressure them to withdraw it
argue about whether the complaint is justified
promise that the complaint will be upheld
refuse to accept a verbal complaint
A complaint and an incident report may both be required. For example a person may make a legitimate complaint while also threatening a staff member. The complaint should be considered fairly and the threatening behaviour should be managed separately.
22. Safeguarding and clinical concerns
Conflict may occur alongside:
suicidal statements
threats towards another person
concerns about a child
domestic abuse
possible exploitation
medication concerns
serious physical symptoms
confusion or altered mental state
concerns about neglect
disclosure of abuse
Administration staff should not allow the conflict to distract them from the safety information.
Follow the relevant procedure and escalate immediately.
Statements such as “I may as well kill myself” should not be dismissed as frustration or manipulation. Alert the appropriate clinician and follow the emergency procedure.
If a child or adult at risk may be unsafe follow the safeguarding procedure. Do not investigate the concern yourself.
23. Confidentiality during conflict
Anger or urgency does not remove the need to protect confidential information.
Do not:
confirm that someone is a patient without appropriate authority
disclose information to a parent or family member automatically
reveal a clinician’s personal telephone number
provide staff home addresses
disclose another patient’s information
leave records visible during an incident
use personal messaging accounts
discuss the incident in public
share screenshots through unauthorised systems
A person may become angrier when information cannot be disclosed. Explain the boundary without revealing confidential details.
For example:
“I understand that you want an immediate answer. I cannot discuss confidential information until we have confirmed the patient’s consent or your authority to receive it. I can record your concerns and ask the appropriate person to review them.”
24. Personal safety and lone working
Lone workers may be at greater risk because immediate support is not nearby. Employers must assess and manage lone-working risks. HSE lone-working guidance
Staff must follow WMI Psychiatry’s lone-working procedure.
This may include:
recording working locations
agreed check-in times
access to a telephone
knowing who to contact
avoiding an isolated meeting with a person whose behaviour presents a concern
arranging for another person to be present
using an alternative location
informing site staff about a foreseeable concern
ending work and leaving if safety cannot be maintained
Home visits or face-to-face contact should not proceed where relevant risk information has not been considered or agreed safety arrangements are unavailable.
Administration staff should not independently approve a visit where a known aggression risk requires clinical or management review.
25. Immediate emergencies
Call 999 where there is:
an assault in progress
an immediate threat to life
a weapon
a serious threat with an apparent intention and ability to act
a person attempting to force entry
serious damage which places people at risk
a medical emergency
an immediate risk of serious self-harm or harm to another person
When calling 999 provide:
your name
your location
the nature of the emergency
whether anyone is injured
whether a weapon is present
a description of the person where relevant
the direction they travelled if they have left
any immediate risk to children or other vulnerable people
Follow the operator’s instructions.
Do not delay the call while seeking management permission.
Once safe:
notify the Registered Manager
notify the Centre Manager or Reception Team where relevant
preserve evidence
complete an incident report
follow safeguarding and data protection procedures where applicable
26. Recording an incident
Record the incident as soon as reasonably possible.
Include:
date and time
location or communication method
people present
what occurred before the incident
observable behaviour
exact words used for significant threats
actions taken to de-escalate
boundaries set
assistance requested
whether emergency services were contacted
any injury or damage
witnesses
relevant communication or accessibility needs
whether children or adults at risk were present
follow-up action
who was notified
whether the event affected future appointments or working arrangements
Use factual language.
Appropriate:
“The caller stated, ‘I will come to the clinic and smash the place up.’ I ended the call and immediately informed the Registered Manager.”
Inappropriate:
“The caller was crazy and probably dangerous.”
Preserve:
emails
messages
voicemails
call records
appointment records
relevant CCTV information where available
photographs of damage where authorised
contemporaneous notes
Do not alter a record to make the response appear better.
Incidents and near misses should be reported even if nobody was injured. HSE notes that repeated minor incidents can precede a more serious event and that staff should not accept violence or abuse as part of the job. HSE health and social care guidance
27. After an incident
The immediate response should include:
checking whether anyone is injured
obtaining medical attention where required
providing a safe and private space
notifying the appropriate manager
relieving the affected staff member from further contact where appropriate
preserving evidence
recording the incident
considering whether police involvement is required
considering safeguarding, data protection or Duty of Candour procedures
agreeing how future contact will be managed
Staff may experience:
shock
anxiety
anger
guilt
disturbed sleep
reduced confidence
difficulty concentrating
fear about returning to work
These reactions do not mean that the staff member managed the incident poorly.
A supportive review should consider:
what happened
what warning signs were present
what helped
what did not help
whether local procedures were clear
whether staffing or environmental factors contributed
whether the risk assessment needs updating
whether additional support or training is required
whether changes are needed before further contact
A review should support learning. It should not be used to blame staff for another person’s abusive or violent behaviour.
28. Preventing future incidents
Organisational prevention may include:
clearer appointment information
transparent fees
reliable response times
consistent communication
accessible complaints information
reasonable adjustments
better waiting-area arrangements
staff alarms
improved lone-working procedures
management review of concerning communication
planned staffing for a particular appointment
informing site reception of a foreseeable concern
changing the method or location of contact
agreeing a communication plan
restricting abusive communication in a proportionate way
reviewing whether WMI Psychiatry can safely continue providing the service
reporting relevant concerns to the police
updating policies and training
A decision to restrict contact or end a service relationship must be authorised and documented. Clinical needs, contractual arrangements, equality duties, safeguarding and continuity of care should be considered.
Administration staff should not independently exclude a patient from the service.
29. Practical scenarios
Scenario 1: Anger about a delayed response
A parent calls because they have not received a reply to two emails. They speak loudly and repeatedly interrupt.
Appropriate response:
acknowledge the frustration
allow them to explain the main concern
summarise what you have understood
check whether there is an urgent clinical issue
explain what action you can take
provide a realistic update time
record the concern
Do not describe the parent as aggressive solely because they are upset.
Scenario 2: Swearing during a telephone call
A caller repeatedly directs swear words at an administrator.
Appropriate response:
“I want to help but I cannot continue while abusive language is directed at me. If it continues I will end the call.”
If it continues end the call and report the incident.
Scenario 3: Threat to attend the clinic
A caller states:
“If this is not fixed today I am coming down there and someone will be sorry.”
Appropriate response:
do not argue
clarify only what is safely necessary
end the call if the threat continues
record the exact words
notify the Registered Manager immediately
alert the Centre Manager or Reception Team
contact police if the threat appears immediate
complete an incident report
Scenario 4: Person blocking the exit
A visitor stands in front of the door and refuses to let an administrator leave.
Appropriate response:
do not attempt to push past
maintain distance
use calm language
summon help
call 999 if there is an immediate threat
leave through another safe route if available
report the incident
Scenario 5: Distressed autistic young person
A young person becomes overwhelmed in a noisy waiting area. They cover their ears, pace and repeatedly ask when the appointment will begin.
Appropriate response:
do not assume aggression
reduce noise where possible
provide clear information
use short sentences
allow processing time
offer a quieter area if safe and available
ask what would help
Scenario 6: Discriminatory abuse
A caller uses racist language towards an administrator.
Appropriate response:
“That language is not acceptable. I am ending the call now.”
The staff member should report the incident and receive support. Another staff member should not require them to resume contact with the caller.
Scenario 7: Complaint combined with a threat
A patient has a legitimate complaint about a cancelled appointment. During the call they threaten to damage the clinic.
The complaint should be recorded and investigated fairly. The threat should also be reported and managed through the safety procedure. One issue does not cancel the other.
Scenario 8: Conflict between parents
Two parents begin shouting at each other in reception.
Appropriate response:
maintain a safe distance
obtain assistance
move other patients away
avoid deciding who is right
do not stand physically between them
follow safeguarding procedures if a child may be at risk
call 999 if violence appears imminent
Scenario 9: Threatening email
An administrator receives an email which names a clinician and states that the sender knows where the clinician lives.
Appropriate response:
do not reply immediately
preserve the email
notify the Registered Manager
protect the clinician’s personal information
consider police involvement
complete an incident report
follow any data breach procedure if information may have been disclosed
Scenario 10: Colleague disagreement
Two administrators disagree about who should have responded to an urgent message.
They should discuss the specific process in private, establish what happened and agree how urgent messages will be managed. If patient safety may have been affected the matter must also be reported through the appropriate procedure.
Scenario 11: Suicidal statement during an angry call
A patient is angry about a prescription delay and states:
“If I do not get it today I will kill myself.”
The administrator should not decide that this is merely frustration. They should alert the responsible clinician and follow the emergency procedure. The administrative concern can be addressed after immediate safety action has been taken.
Scenario 12: Damage to property
A visitor kicks a door and leaves the building.
Do not follow them. Check that everyone is safe, alert site staff, preserve evidence, report the incident and consider police involvement.
30. Key learning points
Conflict is not the same as aggression.
A complaint or firm disagreement should not automatically be labelled as aggressive.
Distress and neurodivergent communication may be mistaken for aggression.
Focus on observable behaviour rather than assumptions.
Speak calmly and use clear language.
Listen and summarise the main concern.
Acknowledge feelings without endorsing abuse.
Offer realistic choices.
Set clear boundaries.
Do not make promises outside your authority.
Keep access to a safe exit.
Seek help early.
You do not need to wait for physical violence before withdrawing.
Administration staff must not use restraint or physical intervention.
End telephone or video contact if it cannot continue safely.
Preserve threatening emails, messages and voicemails.
Call 999 for immediate danger or a serious emergency.
Safeguarding and clinical concerns must still be escalated during conflict.
Confidentiality remains important during urgent or hostile communication.
Report incidents and near misses.
Staff should receive support after an incident.
Violence, threats and abuse are not simply part of the job.
Learning from incidents should inform risk assessments, procedures and training.
Knowledge assessment
Learner instructions
Choose the single best answer.
You must achieve at least 12 out of 15 to pass. Any incorrectly answered safety-critical question must be reviewed even if the overall pass mark is achieved.
Question 1
Which statement best describes conflict?
A. Conflict always involves physical aggression
B. Conflict can involve disagreement without threats or abuse
C. Conflict only occurs when a patient complains
D. Conflict should always be reported to the police
Question 2
A parent speaks loudly because they are upset about a delayed response. What should you do first?
A. Describe them as aggressive
B. End the call immediately
C. Listen, acknowledge the frustration and establish the main concern
D. Tell them that delays are unavoidable
Question 3
Which is an early warning sign that a situation may be escalating?
A. A person politely requesting written information
B. A person asking to make a complaint
C. A person beginning to invade staff members’ personal space
D. A person requesting a reasonable adjustment
Question 4
A visitor blocks the exit and refuses to allow you to leave. What should you do?
A. Push past them
B. Remain in the room until they become calmer
C. Summon help and follow the emergency procedure
D. Attempt to physically remove them
Question 5
Which phrase is most appropriate when setting a boundary?
A. “You are being ridiculous.”
B. “Calm down or else.”
C. “I want to help but I cannot continue while I am being threatened.”
D. “You always behave like this.”
Question 6
What should an administrator do if de-escalation is not working and the situation feels unsafe?
A. Continue until the administrative issue is resolved
B. Move to safety and summon assistance
C. Restrain the person
D. Block the exit to prevent the person leaving
Question 7
Which statement about physical intervention is correct?
A. Administration staff should restrain a person who damages clinic property
B. Administration staff may use any force which seems necessary
C. Administration staff should move to safety and obtain assistance
D. Administration staff should stand between people who are fighting
Question 8
A caller makes a specific threat to attend the clinic with a weapon. What should you do?
A. Treat it as ordinary frustration
B. Delete the call note to avoid alarming staff
C. Record the threat, notify the appropriate manager and contact emergency services where the threat is immediate
D. Challenge the caller to prove that they have a weapon
Question 9
A young autistic person paces, covers their ears and repeats the same question in a noisy waiting area. What is the most appropriate response?
A. Assume that violence is imminent
B. Reduce stimulation, use clear language and ask what would help
C. Tell them to sit still
D. Ask them to leave immediately
Question 10
A patient states during an angry telephone call that they intend to end their life. What should the administrator do?
A. Assume that they are trying to obtain a faster response
B. Promise to prescribe medication
C. Escalate the statement through the clinical emergency procedure
D. End the call and take no further action
Question 11
What should happen to a threatening email?
A. It should be deleted after it has been read
B. It should be preserved and reported
C. It should be forwarded to a personal email account
D. It should be posted in a staff messaging group
Question 12
Which statement about complaints is correct?
A. Making a complaint is itself aggressive behaviour
B. A complaint can be ignored if the person becomes angry
C. The complaint and any abusive behaviour should be managed as separate issues
D. People who complain should have their appointments restricted
Question 13
Which is the most appropriate incident record?
A. “The caller was mad and dangerous.”
B. “The caller was obviously exaggerating.”
C. “The caller stated, ‘I will come to the clinic and smash the windows.’ The Registered Manager was informed immediately.”
D. “The caller was just looking for attention.”
Question 14
Why should near misses and lower-level incidents be reported?
A. To blame the staff member involved
B. To identify patterns and improve safety arrangements
C. To prevent patients from complaining
D. To exclude every person who becomes upset
Question 15
Which best summarises the administration team’s role?
A. Diagnose the cause of aggression and provide treatment
B. Use physical intervention to protect clinic property
C. Communicate calmly, maintain boundaries, move to safety, summon help and report incidents
D. Resolve every disagreement without involving a manager
Learner declaration
Learner’s name: ______________________________
Role: ______________________________
Date completed: ______________________________
Attempt number: ______________________________
I confirm that:
I have completed the full module.
I understand the difference between conflict, distress, aggression and violence.
I know how to contact the Registered Manager.
I know how to obtain help at Salford Innovation Forum.
I know when to call 999.
I understand that I am not expected to remain in an unsafe situation.
I understand that I must not use restraint or physical intervention.
I understand how to set a respectful boundary.
I understand that complaints must still be handled fairly.
I understand that safeguarding and clinical concerns require separate escalation.
I know where incidents and near misses must be recorded.
I understand that threatening communications must be preserved.
I know how to access WMI Psychiatry’s relevant policies.
Signature: ______________________________
Score: ______ / 15
Result: Pass / Further learning required
Safety-critical errors reviewed: Yes / No / Not applicable
Manager or assessor: ______________________________
Renewal date: ______________________________
Manager’s marking guide
Question 1
Correct answer: B
Conflict can involve disagreement, competing expectations or misunderstanding without aggression. Firm communication or a complaint should not automatically be labelled as threatening.
Question 2
Correct answer: C
The administrator should listen, acknowledge the person’s experience and clarify the main concern. Speaking loudly does not by itself establish that the person is aggressive.
Question 3
Correct answer: C
Invading personal space can indicate increasing agitation or intimidation. A complaint or request for information is not an early warning sign by itself.
Question 4
Correct answer: C
Blocking an exit is a serious safety concern. The administrator should not attempt to push past or physically remove the person. They should summon help and follow the emergency procedure.
Question 5
Correct answer: C
The wording acknowledges that the administrator wants to help while clearly identifying the behaviour which prevents the conversation from continuing.
Question 6
Correct answer: B
Personal safety takes priority over resolving the administrative disagreement. Staff should withdraw, obtain help and follow the emergency procedure.
Question 7
Correct answer: C
Administration staff are not trained or authorised to restrain people. They should create distance, move to safety and obtain assistance.
Question 8
Correct answer: C
A specific weapon threat requires immediate escalation. The person’s words and relevant details should be recorded accurately. Emergency services should be contacted if there is an immediate danger.
Question 9
Correct answer: B
The behaviour may reflect sensory overload or distress. Reducing stimulation, communicating clearly and asking what would help are appropriate adjustments.
Question 10
Correct answer: C
A suicidal statement must not be dismissed because it was made during conflict. The administrator should follow the clinical emergency procedure and alert the appropriate clinician.
Question 11
Correct answer: B
Threatening communications may be important evidence. They should be preserved and reported through the appropriate procedure.
Question 12
Correct answer: C
A legitimate complaint should still be considered fairly. Any threats or abuse should be recorded and managed through the safety procedure.
Question 13
Correct answer: C
The record uses observable facts, includes the exact threat and states what action was taken. Judgemental descriptions should not be used.
Question 14
Correct answer: B
Near misses and lower-level incidents can reveal recurring risks. Reporting supports improvements to risk assessments, staffing, procedures and training.
Question 15
Correct answer: C
Administration staff should communicate calmly, set boundaries, prioritise safety, summon help and report incidents. They should not diagnose behaviour or use physical intervention.
Questions 4, 6, 7, 8, 10 and 11 are safety-critical.
For every incorrect answer the manager should:
discuss the correct response with the learner
record that the answer was reviewed
ask the learner to explain the correct procedure
confirm that the learner knows how to obtain immediate help
require reassessment if understanding remains uncertain
A learner must not be recorded as competent if they remain uncertain about:
when to withdraw from an unsafe situation
how to summon assistance
when to call 999
the prohibition on restraint and physical intervention
the escalation of threats, safeguarding concerns or suicidal statements
preserving threatening communications
CQC and governance implementation requirements
Before issuing this module WMI Psychiatry should:
complete all local contact and escalation details
confirm the emergency arrangements at Salford Innovation Forum
confirm how staff summon help
ensure staff know the full address of each working location
ensure the module matches the current policies and risk assessments
confirm lone-working arrangements
identify foreseeable risks associated with face-to-face, remote and telephone work
provide training proportionate to each staff member’s role
confirm that administration staff are not expected to use restraint
provide additional practical training if a risk assessment identifies that e-learning alone is insufficient
ensure exits remain accessible
ensure any alarms or communication equipment are tested
provide clear procedures for managing a threatening visitor
maintain a central incident reporting system
encourage reporting of threats, verbal abuse and near misses
review incident patterns through governance meetings
update risk assessments following relevant incidents
protect staff personal details
provide an approved response for abusive emails and calls
ensure communication restrictions are authorised and proportionate
ensure complaints are considered separately from abusive behaviour
maintain safeguarding and clinical escalation procedures
provide reasonable adjustments for communication and sensory needs
ensure staff receive appropriate support after an incident
consider medical, psychological and practical support following serious events
retain the learner’s answers, score, declaration and attempt number
record completion in the staff training matrix
document review of safety-critical errors
provide refresher training annually
include practical discussion or scenario exercises where appropriate
review whether environmental or procedural changes have reduced risk
report qualifying workplace incidents under applicable legal requirements
ensure senior leaders can demonstrate how incidents lead to learning
CQC Regulation 12 requires care and treatment to be provided safely with risks assessed and mitigated. Regulation 13 requires people using services to be protected from abuse and improper treatment. Conflict management procedures should protect patients, staff and visitors while preserving dignity and avoiding unnecessary restrictions. CQC Regulation 12 and CQC Regulation 13
The educational module supports safe practice but does not replace:
local induction
an environmental risk assessment
practical emergency instruction
suitable staffing
working alarms or communication systems
management support
incident reporting
post-incident review
additional training identified through risk assessment
Further reading and authoritative guidance
Health and Safety Executive: Violence and aggression at work
Health and Safety Executive: Control measures to prevent violence and aggression
Health and Safety Executive: Managing violence and aggression in health and social care
Health and Safety Executive: Advice for workers on violence in the workplace
CQC Regulation 13: Safeguarding service users from abuse and improper treatment
