Read the full summary here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049743/
From a service user perspective (SUPER), the experience of hearing voices, being agitated and seeing things can be confusing, frightening and sometimes terrifying. If people’s voices are shouting at them, putting them down, being derogatory or abusive, then it is perhaps not surprising that people become aggressive and sometimes violent. After all, if someone shouted at you in the street, many people would just shout back! This is what it is like for people who hear voices or see things: it is like someone shouting straight into your ear and never going away.
Many people choose to shout back at their goading voices and this can be taken as being aggressive and violent. No one can hear the voice, the verbal abuse or what the voice is saying, so an aggressive response to hearing an internal voice can seem to come from nowhere. A service user that I met some time ago would often walk along the hospital corridors, screaming back at her voices. She would sometimes hit herself violently on the head, as if trying to physically knock the voices out of her mind. This was seen as aggression and unexplained violence by onlookers, but left me with mixed feelings of pity, consternation and fear.
Similarly, three other people who I met in hospital would often hear voices that seemed to come from the television. This would make them frightened and aggressive. On one occasion, this led to the television being smashed and the individual being forcibly injected with tranquillisers to calm him down.
Unfortunately, some people may become very aggressive or violent towards others. They may have panic attacks or be in emotional turmoil. Sometimes sedatives and tranquillisers are necessary to help people calm down (and some people even ask for them to help them cope).
The use of these sedatives is never ideal, and the use of forced injection can feel like a violation. It can break the trust between the person with mental health problems and nurses. Nurses want to foster and build therapeutic relationships with people. But all the time it takes to build up feelings of trust and intimacy can be broken in an instant, when force is used to restrain or inject the person.
I was unfortunate enough to witness the injection of sedatives on two other occasions: the first time involving a young girl called ‘B’ who was trying to cut herself with the shards of a broken bottle; and the second time a man called ‘R’ who was violently kicking the door of the nurse station and shouting abuse at staff. The use of sedatives in these two situations could perhaps be said to be necessary but never ideal or therapeutic in the long term.
Often, all it takes is for a nurse or member of staff to ‘de-escalate’ the situation. This involves nurses talking to the individual, to calm them down before they become agitated or aggressive. Other techniques, such as seclusion, can often give people some space and time to calm down in their own room.
Service User and Service User Expert
Rethink Mental Illness