This chapter focuses on the management of acutely disturbed patients in psychiatric intensive care units (PICUs). It provides an overview of the nature of acutely disturbed patients, their symptoms and behaviours and the general challenges faced in managing their disturbance. The chapter discusses a philosophy for dealing with disturbed patients, appropriate assessment and care planning and a range of interventions that can be utilised, including verbal de-escalation, medication, physical intervention, seclusion and segregation. It also explores the development of activity and engagement programs for acute disturbance and the training and experience mix required for effective management. The roles of multidisciplinary team (MDT) members in the management of acute disturbance are outlined as well. The chapter highlights the prevalence of violence and aggression in healthcare settings and the importance of creating an informed and supported environment for staff to minimise risks. It concludes with recommendations for ensuring a safe environment and a philosophy of person-centred care in the management of acutely disturbed patients.

It is now common practice for service users to be involved in the training of students and professionals that care for them. This is recognition of the contribution that the unique insights of people’s lived experience can make to the development of practitioners. In this work, two mental health service users share their experiences of facilitating a session on the prevention and management of violence and aggression (PMVA) training delivery. The training is provided to NHS mental health inpatient ward staff and to final year mental health university degree students. The narrative takes one through the recruitment processes for the service user trainers and how they prepare and manage their session. Furthermore, the service-user trainers articulate their uneasiness about the possible effects the disclosure of their restraint experiences could have on them. Their contribution to Middlesex University PMVA team’s training delivery is evaluated through an examination of its impact on practice. From the findings, their contribution has positive impacts on ward practice. This confirms findings from other studies on service user involvement.