Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit.

The study analysed daily log aggregates from one acute mental health unit, so it cannot tell how individual service users responded. Only 249 of 441 prepandemic days had completed logs, a 43.54% missingness rate, and the authors did not impute the missing days. The smaller intervention cluster had only 38 days, so its results are unstable. The models explained little of the variation: conditional R2 was 0.18 to 0.20 for seclusion and physical restraint and 0.28 for situational aggression. Physical injury outcomes were excluded because there were only 11 service-user incidents and 8 nurse incidents. The logs did not record service-user characteristics, time spent using each intervention, or nurse characteristics. Because interventions were not randomised, the associations cannot show that verbal de-escalation caused the reductions.

The authors state the research was conducted, analysed, reported, interpreted and written independently of organisations that funded the first author's PhD scholarship. No other competing interests are reported.

Do not conclude that verbal de-escalation alone prevents seclusion or restraint. This was a retrospective analysis of existing logs, not a randomised comparison, and the authors describe the findings as hypothesis generating.