Call the Phase
A patient becomes quiet, avoids eye contact, and is more withdrawn than earlier
Trigger
Patient pacing and increasingly irritable
Prevent escalation/early intervention
Patient pacing, voice slightly raised
Approach calmly and assess
Telling an angry patient to calm down
Escalates situation
A patient is pacing, voice raised, and refusing redirection
Escalation
Patient yelling but not physically aggressive
De-escalation and communication
Patient escalating verbally
Use de-escalation communication
Patient pacing and irritated
"I want to help - let's step over here and talk."
Ignoring pacing and non-verbal tension
Misses escalation
A patient throws a chair and attempts to strike staff
Crisis
Patient throwing objects
Safety
Patient attempts to hit staff
Call for help/initiate safety measures
Patient yelling and refusing care
"I'm here to keep you safe - let's figure this out together."
Trying to reason during crisis
Ineffective/unsafe
A patient is calm but withdrawn and states, "I messed everything up."
Post-crisis depression
Patient quiet after outburst and expressing guilt
Patient withdrawn after crisis
Assess for suicidal ideation
Post-crisis patient says, "I shouldn't be here."
"Tell me more about what you're feeling right now."
Assuming calm = safe after crisis
Misses suicide risk
A patient appears physically calm but is staring intensely, clenching fists, and not responding to staff
Escalation
Patient refusing care and becoming verbally aggressive
Maintain control of environment and de-escalate
Patient triggered by loud environment
Reduce stimuli
Patient escalating and challenging authority
"I'm not here to argue - I want to help you feel more in control"
Using restraints too early
Increases risk/violates last-resort principle