Combative Psych Patients


For nurses who work in mental health facilities, having to deal with a combative patient could be an everyday event. Learning how to recognize a potentially volatile situation is just one of the many special skills you must learn to develop in order to prevent injury to combative psych patients and to yourself.
You will find that in most facilities, there is a protocol in place for when one of the psychiatric patients begins to exhibit aggressive or combative behaviors. These protocols are unique to each facility, while at the same time adhering to certain standards set forth by mental health experts. Knowing and following these protocols is critical if you wish to remain in control and unharmed during a combative episode.

Is There Strength in Nursing Numbers?

When a patient begins to show violent tendencies, it is natural for your gut reaction to be a call for help. Having multiple nurses may be helpful in certain situations, but evidence suggests that with some patients, this could only aggravate the combativeness. According to evidence gathered in a study – “The Experience of Thought-Disordered Individuals Preceding an Aggressive Incident” – an increase in staff members could prove to be too much stimuli for an already agitated psych patient, causing an escalation in their combative behavior. A perceived sense of losing power could lead to a higher level of anxiety, making it important that you try to first identify the cause of the combative behavior.

The 3 Causes of Combative Psych Patient Behavior

An observational study conducted in the United Kingdom classified three different causes of combative behavior of psychiatric patients housed in medical facilities; the patient, the victim or the environment.

  • Patient Risk Factors: A small minority of combative patients account for a disproportionately high number of combative incidents in a clinical setting. Most of the patients involved have been diagnosed as being schizophrenic, with other risk factors including young age, history of substance abuse and an involuntary admission into the psychiatric facility. Review patient histories carefully, and make note of patients that meet these factors so that you can be on the lookout for sudden bursts of aggression.
  • Victim Risk Factors: The same study cites difficulty in being able to form any conclusion about victim causes of combative behavior by psych patients. It is noted that nurses are the most likely to be targeted, and that trying to physically restrain an agitated patient is often the cause of a personal attack. Having a lack of respect towards the patients and an authoritarian demeanor could also place you at higher risk for causing patient outbursts.
  • Environmental Risk Factors: Not surprisingly, the environment in which psych patients are confined makes a big contribution to the risk of violence. Those facilities who employ trained nurses and other staff members in proper ratio to patients should see a decrease in combative behavior. Not having any type of structured activities, a lack of privacy and a high turnover of nursing staff is also a contributing factor.

Non-Restraining Methods of Dealing With a Combative Psych Patient

The use of restraints to subdue an aggressive psych patient has fallen out of favor over the last 2 decades. Instead, nurses are encouraged to try more calming approaches:

  • De-escalation – This technique requires a nurse to “talk” the patient out of their combative state. Your communication skills must be exemplary in order to be successful, as well as self-knowledge of the non-verbal cues you may be exhibiting. Reading their behavior and having an understanding of their mental illness will also be helpful in de-escalation.
  • Time Out – Suggesting a time out to a combative psych patient is a way of removing them from an over stimulating environment, while still allowing them to feel a sense of control over the situation. This does not necessarily mean seclusion or isolation, but rather a voluntary move to a different room or area. Some psychiatric experts refer to this as a geographical restraint, where a patient is simply put into an environment where they can be managed without fear of harm others or themselves.
  • Medication – Offering calming medications can work in situations where the aggressor is aware that their behavior is non-productive or dangerous. This suggestion can be used as a part of observation and support, usually once the patient has already begun to de-escalate.

When there is a concern for the safety of other patients, the combative patient, yourself or staff members, physical or chemical restraint may be the only option with a combative psych patient. Remember always to follow protocol in these situations, having at least one person in charge of ensuring that the patient’s airways are never being compromised.

Mental health facilities thrive when there is a long term nursing staff that takes a vested interest in the well-being and health of their patients. If this is a specialty you are considering, or if you are already working in this type of setting, know that the more you know about each patient in your care, the better you will be at handling a combative episode.


What Exactly Does A Nurse Do?

Previous article

pH Levels in the Human Body – What Are They?

Next article

You may also like


  1. We are a bunch of volunteers and starting a brand new scheme in our community.
    Your web site offered us with helpful information to work on. You have performed
    a formidable job and our entire group might be thankful to you.

  2. Hi! I know this is kinda off topic nevertheless I’d figured I’d ask.
    Would you be interested in trading links or maybe guest writing a blog article or vice-versa?
    My site addresses a lot of the same subjects as yours and I think we could greatly benefit from each other.
    If you’re interested feel free to shoot me an email.
    I look forward to hearing from you! Superb blog by the way!

  3. It’s very effortless to find out any matter on net as compared to books, as I found this post
    at this website.

  4. Someone essentially help to make seriously posts I would state.
    That is the very first time I frequented your website
    page and so far? I amazed with the analysis you made to create this actual put up amazing.

    Magnificent process!

  5. Hello colleagues, how is all, and what you desire to say concerning this article, in my view its in fact remarkable in favor of me.

  6. I do not know if it’s just me or if perhaps everyone else encountering problems
    with your site. It looks like some of the written text in your content are
    running off the screen. Can somebody else please provide feedback and let me
    know if this is happening to them as well? This might be a problem with my
    internet browser because I’ve had this happen previously.
    Thank you

  7. Hello! I know this is kind of off topic but I was wondering which
    blog platform are you using for this site? I’m getting tired of WordPress because
    I’ve had issues with hackers and I’m looking at
    alternatives for another platform. I would be great if you could point me in the direction of a good platform.

  8. We stumbled over here from a different web page and thought I
    might as well check things out. I like what I see so now i am
    following you. Look forward to going over your web page for a second

  9. Hi, I do believe this is a great blog. I stumbledupon it 😉 I am going to revisit once again since i have bookmarked it.

    Money and freedom is the greatest way to change, may
    you be rich and continue to guide others.

  10. Hello! Quick question that’s entirely off topic. Do you know how to make your
    site mobile friendly? My blog looks weird when browsing from my
    apple iphone. I’m trying to find a theme or plugin that might be able to fix this issue.
    If you have any suggestions, please share. Cheers!
    asmr asmr

  11. Undeniably consider that that you said. Your favorite justification appeared
    to be on the web the easiest factor to take
    note of. I say to you, I definitely get irked at the same time
    as people consider issues that they plainly don’t understand about.
    You managed to hit the nail upon the highest and defined out the entire
    thing with no need side effect , other folks could take a signal.

    Will probably be back to get more. Thanks quest bars quest bars

  12. Having read this I thought it was really informative.
    I appreciate you spending some time and effort
    to put this content together. I once again find myself spending a lot of time both reading and commenting.
    But so what, it was still worth it! scoliosis
    surgery scoliosis

  13. Hey! Do you use Twitter? I’d like to follow you if that would be ok.
    I’m absolutely enjoying your blog and look forward to new updates.
    cheap flights cheap flights

  14. I do not know whether it’s just me or if perhaps everybody else encountering issues with your blog.
    It appears as though some of the text within your content are running
    off the screen. Can somebody else please comment and let me know if this
    is happening to them too? This could be a problem with
    my browser because I’ve had this happen previously.
    Thanks scoliosis surgery scoliosis surgery

  15. It is appropriate time to make some plans for the
    future and it’s time to be happy. I’ve learn this submit and if I may just I want to recommend you some interesting
    things or tips. Maybe you could write next articles relating to
    this article. I desire to read even more issues approximately it!
    quest bars quest bars

Leave a reply

Your email address will not be published. Required fields are marked *

More in Scrubs