De-escalating an agitated patient on a mental health unit
NMC OSCE practice station

The task

You are a registered nurse on an inpatient mental health unit that also supports people with a mild learning disability. Marcus Bell, aged 31, has a mild learning disability and a diagnosis of schizoaffective disorder. He is pacing in the corridor, raising his voice and clenching his fists after being told his planned leave is cancelled. A healthcare assistant is with you. Use verbal de-escalation to help him become calmer and keep everyone safe. Say aloud what you are doing and why. Afterwards, record the incident and say how you would follow it up.

What this station tests

• De-escalation works best early; start with safety, space and a calm voice.
• Listen and acknowledge feelings before giving explanations or limits.
• People with a learning disability need short, clear language and honesty. Do not talk down to them.
• Restraint and sedation are last resorts; document why and what else was tried.
• Debrief both the patient and staff and update the care plan afterwards.

Sources for the clinical content

• NICE NG10: Violence and aggression: short-term management in mental health, health and community settings
• Mental Health Act 1983 Code of Practice
• NMC: The Code

An original practice scenario with invented patients. Not an exam question.

Practise next

• Assessment of a young woman with episodes of sudden fear
• Mental state examination of a withdrawn patient
• Urgent assessment of a woman with persistent low mood