When you think about the number of people in Australia living with mental health conditions – around one in five every year – it’s easy to see why our services need to be both strong and compassionate. Behind every statistic is a person who deserves care that’s safe, respectful and effective. But sometimes, providing this care can be complicated. Certain mental health conditions may come with behaviours that are difficult to manage in a hospital or care setting. These “challenging behaviours” can feel overwhelming for both staff and patients, but with the right understanding and approach, they don’t have to be.

Challenging behaviour is any action that could cause harm to the person themselves, to others, or to property. Importantly, it doesn’t always mean the behaviour is deliberate. For many people living with mental health conditions, these behaviours are a way of expressing distress or unmet needs.

While not intentional, these moments can create barriers between patients and the healthcare workers trying to support them – and can also put others at risk if not handled carefully.
To respond well, it helps to understand why someone may behave this way. Two main sets of triggers are often spoken about:

• Intrinsic factors – things happening inside the person, such as their emotions, physical health, thoughts or mental state.
• Extrinsic factors – what’s happening around them, such as the environment, noise levels, or interactions with others.

This is why the care environment matters so much. Calming, comfortable spaces reduce overstimulation, while activity areas allow patients to connect with others and use positive outlets. If seclusion is needed, it should still be in a safe, open space where patients are visible and supported.

Preparation is everything. Healthcare workers who spend time with mental health patients should be trained not only in risk assessment but also in recognising the subtle warning signs that a person is becoming distressed.

This often involves:

• Talking with the patient (and carers, where appropriate) about what triggers them.
• Learning which behaviours signal they’re struggling.
• Understanding which calming strategies have worked in the past.
• Respecting cultural and personal differences is also vital – what might look like aggression in one context could simply be misunderstood behaviour in another.

There’s no single solution when it comes to descalating these behaviours. The right approach depends on the person, the situation, and the level of risk. However, here are some techniques that can help:

1. De-escalation: This is always the first step. It’s about listening, showing empathy and keeping communication calm and clear. Giving a patient your full attention and avoiding judgment can often prevent a situation from spiralling.
2. Physical intervention and restraint: This should only ever be a last resort when de-escalation hasn’t worked and safety is at risk. If restraint is necessary, it should be brief, respectful and carried out by trained staff who refresh their skills regularly.
3. Patient seclusion: Avoiding seclusion is best – it can feel isolating and impact dignity. But if it is absolutely necessary, the patient must be checked every two hours, provided with essentials (food, water, bedding, toiletries), and given a clear explanation of why it’s happening.
4. Medication: Medication may sometimes be used to calm a patient, but it comes with risks and should be carefully considered. Wherever possible, oral medication should be offered first, giving patients the choice to take it voluntarily before moving to injections.

No matter which strategy is used, documenting what happened – including what triggered the behaviour, what worked, and what didn’t – is essential. This record not only protects staff and patients but also helps guide more effective responses in the future.

Challenging behaviour in mental health care can be confronting, but it’s important to remember that these behaviours usually come from a place of distress rather than intent. By understanding the triggers – both internal and external – and approaching each situation with patience, empathy, and the right strategies, healthcare providers can make a real difference.